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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date: 6-l9-g5 <br />• Site: Beacon 0695 Pro3ect No. : 94-695-01 <br /> 900 S . Cherokee Lane Well Designation: mw- ,b-- <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? NO 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) : !�i <br /> Well cover type: 8" W 12" W 12" EMCO 8" BK <br /> 12" BK 12" DWP 12" CNI 36" CNI Other <br /> General condition of wellhead assembly, Excellent oo Fair Poor <br /> Purging Equipment: 2" disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer =]\I Centrifugal pump <br /> Sampled with: Disposal bailer:_ Teflon bailer: <br /> Well Diameter: 2" 4" X 6T1 8" <br /> Purge Vol. Multiplier: 0 . 16 0 . 65 1. 47 2 . 61 gal/ft. <br />• Initial Measurement Recharge Measurement <br /> Time: 410 Time: q U 0Calculated purge: L 7 <br /> Depth of well: 77./$ Depth to water: 6 2 Actual purge:"Y1 . <br /> Depth to water: & <br /> Start purge: l5 Sampling time: 4 4�_ <br /> Time Temp. E. C. pH Turbidity Volume <br /> 7 6,1 7J3 <br /> quo 0.3 <br /> �'s Q P 65Z 7z0 <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: Panned Allenhead (DWP) : <br /> Remarks: <br /> Signature: <br /> fj� <br />