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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date: <br /> Site: Beacon #695 Prosect No. : - 94-695-01 <br /> 900 S . Cherokee Lane Well Designation: <br /> Lodi CA <br /> Is setup of traffic control devices required? YES time: hours <br /> Is there standing water in well boxes % YES Above TOC Below TOC <br /> Is top of casing cut level? NO JED If no, see remarks <br /> Is well cap sealed and locked' NO � If no, see remarks <br /> Height of well casing riser ( in inches) : <br /> Well cover type: 8" UV 12" W12" EMCO 8" BK <br /> 1211 BK 121" DWP 1211 CNI 3 6" CNI -Y her <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 baile�r/ Centrifugal pump <br /> Sampled with: Disposal bailer: it Teflon bailer: <br /> Well Diameter: 2" 4" 6 T 8" <br /> Purge Vol. Multiplier: 0 . 16 0 . 65 1 . 47 2 61 gal/ft. <br /> Initial Measurement Recharge Measurement <br />. <br /> Time". Time: A Calculated purge:, AJ t+ <br /> Depth of well: �- Depth to water: 6 7 zl Actual purge:- �►S rf <br /> Depth to water: 06-4 <br /> Start purge: l n Sampling time• 0c) <br /> Time Temp. E. C. pH Turbidity Volume <br /> L33 6�, � 9 �1 l� ` <br /> Z3q 706 <br /> 76J <br /> Sample appearance: - -G-_.,. Lock: mfr' - <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: 9/26 Bolt: <br /> 6" Locking Cap: Pinned Allenhead (DWP) : <br /> • Remarks: <br /> Signature: ' <br />