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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFOFJ4ATI0N SHEET - <br /> Client: Ultramar Sampling Date: <br /> is Site._ Beacon 0695 Project No. : 94-695-01 <br /> 900 S Cherokee Lane Well Designation: MW- / �7 <br /> i <br /> Lodi, CA <br /> Is setup of traffic control devices required? YES time: hours <br /> Is there standing water in well box' S Above TOC Below 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) : .L "'J <br /> Well cover type: 8 " UV 12" UV 12" EMCO 8" BK <br /> 12" BK 12" DWP 12 " CNI- 36" CNS other <br /> General condition of wellhead assem ly: Excellent G004 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" 8'w <br /> Purge Val. Multiplier: 0 . 16 0 . 65 1 . 47 2 . 61 gal/ft. <br /> Initial Measurement Recharge Measurement <br /> Time: Time : i0c.EZ Calculated purge <br /> Depth of well: Cri u7 Depth to water: _ nActual purge: /. '2- <br /> Depth <br /> urge: /• `1Depth to water: 60- ?S- <br /> Start <br /> 0?S-Start purge: Klr ^� Sampling time. <br /> Time Temp. E. C. pH Turbidity Volume <br /> 741, <br /> Sample appearance: 422=e:: _ _ Lock: �.. - <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 2" Locking Cap: Lock 03753 : 7/32 Allenhead: <br /> 4" Locking Cap: Lock-Dolphin: 9/16 Bolt: <br /> 6" Locking Cap: Pinned Allenhead (DWP) : <br /> Remarks : <br /> Signature: i/ „ - � <br />