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DOULOS BNVIROMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> s <br /> Client: Ultramar Sampling Date: ° 17 <br /> Site:. Beacon 1695 Project No. : 94-695-01 <br /> I <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 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: 811 UV 1211 UV 1211 EMCO 8" BK <br /> 1211 BK 1211 DWP 1211 CNI 3611 CNIX Other <br /> General condition of wellhead assembly: Excellent <5oo Fair Poor <br /> Purging Equipment: 211 disposable bailer Submersible pump <br /> 211 PVC bailer Dedicated bailer <br /> 411 PVC bailer X Centrifugal pump <br /> Sampled with: Disposal bailer:- X Teflon bailer: <br /> Well Diameter: 211 411 611,X— 811 <br /> Purge Vol. Multiplier: 0. 16 0.65 1. 47 2 . 61 gal/ft. <br /> Initial Measurement Recharge Measurement 0, 60 r <br /> Time: Time: i 3 0 Calculated purge: <br />' Depth of well: 83 .5 r Depth to water: 7 j Actual purge: 90.6 01 <br /> Depth to water: =0 0 <br /> Start purge:.!/ 0 Sampling time: 3 5 <br /> Time Temp. E.C. pH Turbidity Volume <br /> •sa 6S 5 t0..10 6• S& 3 <br /> 10 I 9 4 <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 /> 611 Locking Cap: Pinned Allenhead (DWP) : <br /> Remarks: <br />• Signature: <br />