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S <br /> DOU+08 ENVIROHNBNTAL COMPANY SAMPLING INFORMATION SHEET <br /> " Client: Ultramar Sampling Date: 1 2 w 17 - q <br /> 1 site: Beacon #695 Project No. :. 9.4-695-01_ <br /> r 900 S. Cherokee Lane Well Designation: MW <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 If no, see remarks <br /> Height of well casing riser (in inches) : 4 <br /> Well cover type: 8" UV 1211 UV 12" EMCO 81' BK <br /> 12" BK 12" DWP 12" CNI 36" CNI then <br /> General condition of wellhead assembly: Excellent oo Fair Poor <br /> Purging Equipment: X211 disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer Centrifugal pump <br /> Sampled with: Disposal bailer: X Teflon bailer: <br /> Well Diameter: 2" X 4" 6" 811 <br /> Purge Vol. Multiplier: 0. 16 0. 65 1.47 2 . 61 gal/ft. _ <br /> Initial Measurement Recharge Measurement ! <br /> Time: Time: 5 Sf Calculated purge: <br /> Depth of well: 70 30 Depth to water: 69 - 13 _ Actual purge: r <br /> Depth to water: 6 8 . 01 <br />.Start purge: 10 ' 30 Sampling time: 1 r • OD <br /> Time Temp. E.C. pH Turbidity Volume <br /> lv 5 69 3 -7 6 <br /> 10 45 6 C, 3 60 7 5 9 3 <br /> 9 7 5 1 7 q f -r--- y <br /> Sample appearance: Lock: <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 2" Locking Cap: Lock 13753: 7/32 Allenhead: <br /> 4" Locking Cap: Lock-Dolphin: 9/16 Bolt: <br /> 6" Locking Cap: Pinned Allenhead (DWP) : <br />. Remarks: <br />*Signature: <br /> r <br />