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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date: a-19-9s <br /> Site: Beacon 1695 _ Project No. : 94-695-01 <br /> 900 S. Cherokee Lane Well Designation: MW- 1�_ <br /> Lodi- CA <br /> Is setup of traffic control devices required? <n YES time: hours <br /> Is there standing water in well box? YES Above TOC Below TOC <br /> Is top of casing cut level? NO If no, see remarks <br /> Is well cap sealed and locked? NO E If no, see remarks <br /> Height of well casing riser (in inches) : 4T <br /> Well cover type: 8" UV 12" UV 1211 EMCO 811 BK <br /> 1219 BK 1211 DWPk _ 1211 CNI 361' CNI Other <br /> General condition of wellhead assembly: Excellent oo Fair Poor <br /> Purging Equipment: - A'_211 disposable bailer Submersible pump <br /> 211 PVC bailer Dedicated bailer <br /> 411 PVC bailer Centrifugal pump <br /> Sampled with: Disposal bailer: Teflon bailer: <br /> Well Diameter: 2f1 419 611 811 <br /> Purge Vol. Multiplier: 0. 16 0.65 1. 47 2 . 61 gal/ft. <br /> Initial Measurement Recharge Measurement <br /> Time: ads Time:----- _A '_49 Calculated purge:./.e - <br /> Depth of well: C9 YC Depth to water:_A L I g_ Actual purge: <br /> Depth to water: 66-S'2 <br /> Start purge: 1125 Sampling time: 116 8 <br /> Time Temp. E.C. pH Turbidity Volume <br /> J) 4O 7A )-- "T <br /> Sample appearance: Lock: <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 2" Locking Cap: Lock 13753 : 7/32 Allenhead: <br /> 4" Locking Cap: Lock--Dolphin: 9/16 Bolt: <br /> 611 Locking Cap: Pinned Allenhead (DWP) : <br /> Remarks: <br /> Signature: <br />