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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date: b1,1ff_ <br /> Site: Beacon t695 Project No. : 94-695-01 <br /> 900 S . Cherokee Lane Well Designation: /�w <br /> Lodi CA <br /> i i�r-irrrnrrrrrru n�� <br /> Is setup of traffic control devices required YES time : hours <br /> Is there standing water in well box'' YES Above TOC Below TOC <br /> Is top of casing cut level? t yarS1 If no, see remarks <br /> Is well cap sealed and locked"' NO If no, see remarks <br /> Height of well casing riser ( in inches) : t _ <br /> Well cover type: 8" UV 12" W 12" EMCOr 8" BK <br /> 12'1 BK 12" DWP 12 " CNI 36" CNI her <br /> General condition of w6ellhead assembly: Excellent G000l Fair Poor <br /> Purging Equipment. 2" disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer __Centrifugal pump <br /> k <br /> Sampled with- Disposal bailer: L Teflon bailer: <br /> Y ' <br /> Well Diameter: 211� 411 6" 811 <br /> Purge Vol . Multiplier: 0 . 16 0 . 65 1.47 2 . 61 gal/ft. <br /> Initial Measurement Recharge Measurement <br /> Time: N, d �, �� Time: L4 Raj r Calculated purge: �� � T <br /> Depth of well. 6 Depth to water: Actual. purge. <br /> Depth to water:6 S.�4 <br /> Start purge: �'� �G Sampling time: r00___ <br /> Time Temp. E. C. pH Turbidity Volume <br /> 711 <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: ' <br />