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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: '1 <br /> Lodi , CA <br /> Is setup of traffic control devices required? 2 YES tame: hours <br /> Is there standing water in well box? ES Above TOC Below TOC <br /> Is top of casing cut level' NO E If no , see remarks <br /> Is well cap sealed and locked' NQ If no, see remarks <br /> Height of well casing riser ( in inches) - 6 <br /> Well cover type: 8" UV 12" UV 12" EMCO 8" BK <br /> 12" BK 12" DWP 12 " CNI 36" CNI ther <br /> General condition of ellhead assembly: Excellent Goa 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:Y Teflon bailer: <br /> Well Diameter: 2" 4" 6`r 8" <br /> I <br /> Purge Vol. Multiplier: 0 . 16 0 . 65 1 . 47 2 . 61 gal/ft. <br /> Initial Measurement Recharge Measurement <br /> Time: Ill-f Time: %k3j Calculated purge: Z <br /> Depth of well: S SL- Depth to water: Actual purge: ,),14 <br /> Depth to water: 6< d-9 <br /> Start purge: 3 J Sampling time: Ljqd <br /> Time Temp. E. C. pH Turbidity Volume <br /> r, <br /> 3.3 T 6 � q 7 x- 14 <br /> 3 6S- 7 6 7 I <br /> 6 -7L3 <br /> Sample appearance: c:i ^ Lock: ter ' <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" Lacking Cap: Pinned Allenhead (DWP) : <br /> Remarks : <br /> Signature: <br />