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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: <br /> Lodi, _CA <br /> Is setup of traffic control devices required NQ YES time: hours <br /> Is there standing water in well boxes} YES Above TOC Below TOC <br /> Is top of casing cut level? NZ5 cM If no, see remarks <br /> Is well cap sealed and locked NO YES If no, see remarks <br /> Height of well casing riser ( in inches) : 3 v <br /> Well cover type: 8" UV 12" W 12" EMCO 8" BK <br /> 1211 BK 1211 DWP 1211 CNI 3611 CNI Other <br /> General condition of wellhead assembly: Excellent Good Fair Poor <br /> Purging Equipment: 21' disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer f Centrifugal pump <br /> Sampled with: Disposal bailer:—Z-- Teflon bailer: <br /> Well Diameter: 2" X 4" 6" 8" <br /> T� <br /> Purge Vol . Multiplier: 0 . 16 0 . 65 1. 47 2 . 61 gal/ft. <br /> Initial Measurement Recharae Measurement <br /> Time: �.� r Time: Calculated purge: <br /> Depth of well: o't 1 Depth to water:,_,{4 r 47 LI Actual purge: ,h? :v <br /> Depth to water:-" 61 <br /> " <br /> Start purge: Sampling time: iLi <br /> Time Temp. E. C. pH Turbidity Volume <br /> 0 1 !r /f . r tr �---�- 1 <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: GAr1,/s A <br />