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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date: 3_.1 q-q-5 <br /> Site: Beacon #695 Pro3ect No. : 94-695-01 <br /> 900 S. Cherokee Lane Well Designation: PAW-a2 <br /> Lodi, CA <br /> Is setup of traffic control devices required? IO YES time: hours <br /> Is there standing water in well box? �f 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) : <br /> Well cover type: 811 W 12" UV 1211 EMCO 811 BK <br /> 1210 BR 1211 DWP 12 10 CNI 3 610 CNI Other <br /> General condition of wellhead assembly: Excellent ooc Fair Poor <br /> Purging Equipment: 211 disposable bailer Submersible pump <br /> 211 PVC bailer Dedicated bailer <br /> 411 PVC bailer rCentrifugal pump <br /> Sampled with: Disposal bailer:. . Teflon bailer: <br /> Well Diameter: 211 4" 699 819 <br /> Purge Vol. Multiplier: 0. 16 0. 65 1.47 2. 61 gal/ft. <br /> Initial Measurement Recharge Measurement <br /> Time: _ Time: -Iz 4— Calculated purge:_ <br /> Depth of well: ?D. Depth to water: Actual purge: <br /> Depth to water: 61..11 <br /> Start purge:_1157 Sampling time: 1.2-3S_ _ <br /> Time Temp. E.C. pH Turbidity Volume <br /> 1W 1V62 i 969 1 <br /> r4ol �L, 1431 65 <br /> j.-°S <br /> 761 It <br /> Sample appearance: Lock: <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 2" Locking Cap: Lock ,x`3753 : 7/32 Allenhead: <br /> 4" Locking Cap: Lock-Dolphin: 9/16 Bolt: <br /> 6" Locking Cap: Pinned Allenhead (DWP) :_ <br /> Remarks: <br /> Signature: <br />