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DOULOS ENVIROMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> ! Client: Ultramar Sampling Date: 7- CIV <br /> Site: Beacon #695 Project No. : 94-695-01 <br /> 90.0 S. Cherokee Lane Well Designation: <br /> Lodi, CA <br /> Is setup of traffic control devices required? dV YES time: hours <br /> Is there standing water in well box? (0 YES Above TOC Below TOC <br /> Is top of casing cut level? NO (!gVP If no, see remarks <br /> Is well cap sealed and locked? N¢ � If no, see remarks <br /> Height of well casing riser (in inches) : b <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 oo 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" 4" 6f1 8" <br /> Purge Vol. Multiplier: 0 . 16 0.65 1. 47 2 . 61 gal/ft. <br /> Initial Measurement Recharge Measurement <br />' Time: Q 55 Time: �� S 5 Calculated purge: � 5 <br /> Depth of well: r - r Depth to water: Actual purge: -75 q <br /> Depth to water: <br />. Start purge: D Sampling time: 3 d <br /> Time Temp. E.C. pH Turbidity Volume <br /> 0 , 7 <br /> 3 = qa / 5 10 7_ 9 3 <br /> Sample appearance: on- Lock: .n <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 />