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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMA7TION SHEET <br /> Client: Ultramar Sampling Date:_J�,-_ <br /> Site: Beacon 4695 Project No. : 94-695-01 <br /> 900 S. Cherokee Lane Well Designation: MW- <br /> Lodi,--CA - <br /> Is <br /> - <br /> Lodi. CAIs 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) : <br /> Well cover type: 8" UV 12" W 12" EMCO 8" BK <br /> 12" BK 12" DWP 12" CNI 36" CNI other <br /> General condition of wellhead assembly: Excellent 4;� Fair Poor <br /> Purging Equipment: 2" disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer _-Centrifugal pump <br /> Sampled with: Disposal bailer: Teflon bailer: <br /> Well Diameter: 2" 419�X 6" 8" <br /> Purge Vol. Multiplier: 0. 16 0. 65 1.47 2. 61 gal/ft. <br /> Initial Measurement Recharge Measurement oo�� <br /> Time: Time: 15 q Calculated purge: <br /> tDepth of well: 68 Depth to water: 9- Actual purger <br /> Depth to water: Q <br /> Start purge: 30 Sampling time: <br /> Time Temp. E.C. pH Turbidity Volume <br /> ? � 6 3 763 , 3 <br /> r4y 7 757 7. 5- 1 <br /> 1 . 50 69 . 9 7 9 1 7. 9 <br /> Sample appearance: Lock: 4-r) <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 2" Locking Cap: Lock , 3753 : 7/32 Allenhead: <br /> 411 Locking Cap: Lock-Dolphin: 9/16 Bolt: <br /> 6" Locking Cap: Pinned Allenhead (DWP) : <br />. Remarks: <br /> Signature: <br />