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D0UL08 ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date: `-��al.� <br /> Site: Beacon #695 Project No. : -94-695-01 <br /> 900 S. Cherokee Lane Well Designation: MW- <br /> Lodi, CA <br /> Is setup of traffic control devices required? YES time: hours <br /> Is there standing water in well box? YES Above TOC Below TOC <br /> Is top of casing cut level? a <MIf no, see remarks <br /> Is well cap sealed and locked? NO If no, see remarks <br /> Height of well casing riser (in inches) : 3 . <br /> Well cover type: 811 UV 12" UV 1211 EMCO 811 BK <br /> 1211 BK 1210 DWP 1219 CNIY _ 36t1 CNI Other <br /> General condition of wellhead assembly: Excellent oo Fair Poor <br /> _ wm�a�nnn•ia ui�i...m,.. <br /> Purging Equipment: 210 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: 210„ 410 611 811 <br /> Purge Vol. Multiplier: 0. 16 0. 65 1.47 2 .61 gal/ft. <br /> Initial Measurement Recharge Measurement <br /> Time: Time: _L44 Calculated purge:S IA <br /> Depth of well: 75 rs-f Depth to water: i�CC 67 Actual purge:S ca <br /> Depth to water:6 1.4L <br /> Start purge: 1311 Sampling time: 145 <br /> Time Temp. E.C. pH Turbidity Volume <br /> 2-37 <br /> Sample appearance: — � ...,� Lock: <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 211 Locking Cap: Lock 93753 : 7/32 Allenhead: <br /> 411 Locking Cap: Lock-Dolphin: 9/16 Bolt: <br /> 611 Locking Cap: Pinned Allenhead (DWP) : <br /> Remarks: <br /> Signature: <br />