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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date: 6- lq -g5 <br /> Site: Beacon #695 Pro3ect No. : 94-695-01 <br /> 900 S . Cherokee Lane Well Designation: /1w <br /> Lodi CA <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' N If no, see remarks <br /> Is well cap sealed and locked N YE If no, see remarks <br /> Height of well casing riser (in inches) : <br /> Well cover type: 8" UV 12" U 12" EMCO 8" BK <br /> 12" BK 12" DWPZ— 12" CNI 36" CNI ther <br /> General condition of wellhead assembly: Excellent 5E Zoo 4 Fair Poor <br /> Purging Equipment: _21, disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailerCentrifugal pump <br /> Sampled with: Disposal bailer: Teflon bailer: <br /> Well Diameter: 2" �/ 4" 6'r 8" <br /> Purge Vol. Multiplier: 0 . 16 0 . 65 1. 47 2 . 61 gal/ft. <br /> Initial Measurement Recharge Measurement /� <br /> Time: 11,�L, Time: Calculated purge: ,3 / 5' <br /> Depth of well: 65 Depth to water _zr Actual purger i <br /> Depth to water:—MILL- <br /> Start purge: 3 /4 Sampling time, <br /> Time Temp. E. C. pH Turbidity Volume <br /> 3 is 7 `7 6 7y3 <br /> 31-7 7� 6 60-)- 7T 4 ------- <br /> 311 73g 6 CO 7116 .j <br /> 7J- 7 607 7,14 `7 <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 />