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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date: <br /> Site:_ Beacon-#695 _ Project No. : 94-695-01 <br /> 900 S. Cherokee Lane Well Designation: MW-.�',5 _ <br /> Lodi, CA <br /> Is setup of traffic control devices required? YES time: hours <br /> Is there standing water in well box? NO Jj%� Above 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: 811 UV 1211 UV 1211 EMCO 811 BK <br /> 1211 BK 1211 DWP_ae_— 1211 CNI 3611 CNI ther <br /> General condition of wellhead assembly: Excellent Fair Poor <br /> Purging Equipment: =X 211 disposable bailer Submersible pump <br /> 219 PVC bailer Dedicated bailer <br /> 411 PVC bailer Centrifugal pump <br /> Sampled with: Disposal bailer: J-,""' Teflon bailer: <br /> Well Diameter: 2f1 4t° 611 8" <br /> Purge Vol. Multiplier: 0. 16 0. 65 1.47 2 . 61 gal/ft. <br /> Initial Measurement Recharge -Measurement <br /> Time: fs;.7 Time: Calculated purge:--I.Voi <br /> Depth of well: Depth to water: KK.10 -� Actual purge: 9-1 f <br /> Depth to grater <br /> Start purge: 3 Pr _ Sampling time: J]D <br /> Time Temp. E.C. pH Turbidity Volume <br /> D 71, 2_ / <br /> 3-411- 747 2, <br /> )_4 72-ir <br /> Sample appearance: CALock: <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 211 Locking Cap: Lock §3753: 7/32 Allenhead: <br /> 411 Locking Cap: Lock-Dolphin: 9/16 Bolt: <br /> 611 Locking Cap: _ Pinned Allenhead (DWP)^: <br /> Remarks: <br /> Signature: <br />