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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date: 6 -/,3'q5- <br /> Site• Beacon 1695 Pro]ect No . : 94-695-01 <br /> 0j RW <br /> 900 S Cherokee Lane well Designation: UK <br /> Lodz CA <br /> Is setup of traffic control devices required' 1q YES time: hours <br /> Is there standing water in well box? YES Above TOC Below TOC <br /> Is top of casing cut level? NO QTIf no, see remarks <br /> Is well cap sealed and locked NO qS If no, see remarks <br /> Height of well casing riser (in inches) : <br /> Well cover type: 8" UV 12" UV 121"N CO 8" BK <br /> 12" BK 1211 DWP 1211 CNI 3611 CNI then <br /> General condition of wellhead assembly: Excellent o Fair Poor <br /> Purging Equipment: 2" disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailerCentrifugal pump <br /> Sampled with: Disposal bailer: J/^ Teflon bailer: <br /> Well Diameter: 2" 4" 61r 8" <br /> Purge Vol . Multiplier: 0 . 1.6 0 65 1. 47 2 . 61 gal/ft. <br /> Initial Measurement Recharge Measurement <br /> `+ Time: 2-0* Time: �,--F1 Calculated purge: <br /> Depth of well: _�1 Ct Depth to water: o S�s T�_ Actual purge: RM 2!1 <br /> Depth to water:Cr C <br /> Start purge: MQ Sampling time: <br /> Time Temp. E. C. pH Turbidity Volume <br /> 710 11 r,7 <br /> '�7 �4� i� 3 <br /> 236 7z-6 <br /> Sample appearance: r 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: Pinned A11.enhead6 <br /> 6 Locking Cap; DWP) : <br />•'� <br /> Remarks: <br /> Signature: <br />