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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET- <br /> Client: Ultramar Sampling Date:_ s -i` �9.'�__ <br /> iSite: Beacon 0695 Protect No. : 94-695-01 <br /> 900 S Cherokee Lane Well Designation: MW-241 <br /> Lodi CA <br /> Is setup of traffic control, devices required O YES time: hours <br /> Is there standing water in well box? YES Above TOC Below TOC <br /> Is top of casing cut leveler 96 1 <br /> QP If no, see remarks <br /> Is well cap sealed and locked? NO E If no, see remarks <br /> Height of well casing riser (in inches) : <br /> Well cover type: 811 UV 12" UV 12" CO 8" BK <br /> 1211 BK 12" DWP 12" CNI 'r CNI Other <br /> General condition of wellhead assembly: MItellent -0-3,111Fair 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: j"' <br /> Teflon bailer: <br /> Well Diameter; 211 411 7 611 all <br /> Purge Vol. Multiplier: 0 . 16 0 . 65 1. 47 2 . 61 gal/ft. <br /> Initial Measurement Rechar a Measurement , � � <br /> Time: 2_1 Time : ' y Q Calculated purge:— - <br /> Depth of well: 75&I Depth to water: Actual purge: �_6 1� <br /> Depth to water:66 K W <br /> Start purge: US Sampling time: <br /> Time Temp . E.C. pH Turbidity Volume <br /> :,r r <br /> O / <br /> 7 S q 2-7 7.L6 <br /> Sample appearance: Lock: �- <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 2" Locking Cap : Lock 93753 : 7/32 Allenhead: <br /> 4" Locking Cap: Lock-Dolphin: 9/16 Bolt: <br /> 6" Locking Cap: Pinned Allenhead (DWP) : <br /> Remarks : <br /> Signature: <br /> J <br />