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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date: <br /> Site: Beacon #695 Pro3ect No . : 94-695-01 <br /> 900 S . Cherokee Lane Well Designation: MW- f <br /> Lodi , CA <br /> Is setup of traffic control devices required? YES time: hours <br /> Is there standing water in well box? Y'S Above TOC Below TOC <br /> Is top of casing cut level' 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 12" UV 12" EMCO 8" BK <br /> 12" BK 1.2" DWP 12 " CNIT 36" CNIther <br /> General condition of wellhead assembly: Excellent 00 <br /> Fair Poor <br /> Purging Equipment: 2" disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer Centrifugal pump <br /> Sampled with: Disposal bailer: Teflon bailer: <br /> Well Diameter: 2" 4" 6" g" <br /> Purge Vol . Multiplier: 0 . 16 0 . 65 1 . 47 2 . 61 gal/£t. <br /> Initial Measurement Recharge Measurement <br /> Time: of.I Time: e /q Calculated purge: <br /> Depth of well: r Depth to water: /� Actual purge: /, <br /> Depth to water .� <br /> Start purge: F�0 Sampling time: 6.zs <br /> Time Temp. E. C. pH Turbidity Volume <br /> IT <br /> Sample appearance: Lock; <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 2" Locking Cap: Lock #3753 : 7/32 Allenhead. <br /> 4" Locking Cap: Lock-Dolphin: 9/16 Bolt: <br /> 6" Locking Cap: Pinned Allenhead (DWP) : <br /> Remarks : <br /> Signature: 2/ <br />