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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date: ._ 3-�-�- - <br /> Site:­ Beacon X695 Project No. : 94-695-01 <br /> 900 S. Cherokee Lane Well Designation: MW-A9 <br /> Lodi CA <br /> Is setup of traffic control devices required? O YES time: hours <br /> Is there standing water in well box? YES Above TOC Below TOC <br /> Is top of casing cut level? E If no, see remarks <br /> Is well cap sealed and locked? NOE 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 /> 12'4 Bl 1219 DWP U 10 CNIk_ 36" CNI Other. <br /> General condition of wellheacfVassembly: Excellent oo Fair Poor <br /> Purging Equipment: 210 disposable bailer _ Submersible pump <br /> 211 PVC bailer Dedicated bailer <br /> 410 PVC bailer Centrifugal pump <br /> Sampled with: Disposal bailer: Teflon bailer: <br /> Well Diameter: 210 4" 610 814 <br /> Purge Vol. Multiplier: 0. 16 0. 65 1..47 2 . 61 gal/ft. <br /> Initial Measurement Recharge Measurement <br /> Time: 6316 Time: _ . ,/?AJ Calculated purge: X 3 <br /> Depth of well: 76"fig Depth to water: Actual purge: <br /> Depth to water: 69,y:6 <br /> Start purge: iD O Sampling time: .� <br /> Time Temp. E.C. pH Turbidity Volume <br /> -L. <br /> 7 i. y -------- 3 <br /> 7411 <br /> Sample appearance: _� 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 />