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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date: -/Cl'�� <br /> Site: Beacon 0695 _ Project No. : 94-695-01 <br /> 900 S . Cherokee Lane Well Designation: KW- <br /> Lodi , CA <br /> Is setup of traffic control devices required' YES time: hours <br /> Is there standing water in well box'' O YES Above TOC Below TOC <br /> Is top of casing cut level? NO 'ig� If no, see remarks <br /> Is well cap sealed and locked? NoYZ- <br /> Height of well casing riser (in inches) : <br /> Well cover type: 8" UV 1.2" UV 12" EMCO 8" BK <br /> 12" BK 12" DWP 12" CNI 36" CNIther <br /> General condition of wellhead assembly: Excellent o Fair Poor <br /> Purging Equipment: Z" 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" <br /> Purge Vol. . Multiplier: 0 . 16 0 . 65 1. 47 2 . 61 gal/ft. <br />. Initial Measurement Recharge Measurement <br /> Time: f \. a Time: 601 Calculated purge: <br /> Depth of well. 75' r--k Depth to water: 6 ifs Actual purge:_ri <br /> Depth to water: 67 -16 <br /> Start purge: S,5' Sampling time- 6/0 <br /> Time Temp. E.C. pH Turbidity Volume <br /> w <br /> Sample appearance: 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: <br />