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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date: -al-9.5_ <br /> Site:. Beacon #695 Project No. : 94-695-01 <br /> 900 S. Cherokee Lane Well Designation: MW-3,Q <br /> Lodi CA <br /> Is setup of traffic control devices required? YES time: hours <br /> Is there standing water in well box? Q 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 If no, see remarks <br /> Height of well casing riser (in inches) : <br /> Well cover type: 8" UV 1211 UV 121° EMCO 811 BK <br /> 1211 BK 12 f1 DWP121° CNI 3611 CNI Other <br /> General condition of 11head assembly: Excellent oo Fair Poor <br /> Purging Equipment: ,.211 disposable bailer Submersible pump <br /> 211 PVC bailer Dedicated bailer <br /> 4" PVC bailer Centrifugal pump <br /> Sampled with: Disposal bailer: Teflon bailer: <br /> Well Diameter: 2°° � 4" 610 811 <br /> Purge Vol. Multiplier: 0. 16 0. 65 1.47 2. 61 gal/ft. <br /> Initial Measurement Recharge Measurement <br /> Time:_... Time: <br /> 8 Calculated purge: 1.1 <br /> Depth of well: 9-9.6,9 Depth to water:_6� Q Actual purge: ! 1 •• <br /> Depth to water:._ CT-i;)- <br /> Start purge: 10 3i' Sampling time: 1D CS <br /> Time Temp. E.C. pH Turbidity Volume <br /> 1 aj7 26)- <br /> 1031 <br /> �. 13 b ' 1a039 �'• ! 6J �. <br /> 7 5r? <br /> Sample appearance: C�� ot,_ Lock: <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 211 Locking Cap: Lock 03753 : 7/32 Allenhead: <br /> 411 Locking Cap: Lock-Dolphin: 9/16 Bolt: <br /> 611 Locking Cap: Pinned Allenhead (DWP) : <br /> Remarks: <br /> Signature: <br />