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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date:5-_)_7_q i <br /> iSite: Beacon #695 Pro3ect No. : 94-695-01 <br /> 900 S. Cherokee Lane Well Designation: MW- <br /> Lodi, CA <br /> Is setup of traffic control devices required? NO YES time: hours <br /> Is there standing water in well box' YES Above TOC Below TOC <br /> Is top of casing cut level? NO E If no, see remarks <br /> Is well cap sealed and locked' NO E If no, see remarks <br /> Height of well casing riser (in inches) : <br /> Well cover type: 8" UV 12" UV12' EMCO 8" BK <br /> 12" BK 12" DWP 12" CNI k 36" CNI Other <br /> General condition of wellhead assembly: Excellent oo Fair Poor <br /> 11-1 <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:-k— Teflon bailer: <br /> Well Diameter: 211_ 4" 6" 8" <br /> Purge Vol. Multiplier: 0. 16 0 . 65 1. 47 2 . 61 gal/ft. <br /> Initial Measurement Recharge Measurement <br /> Time: . LS1 Time: J- Calculated purge: 144-1 <br /> Depth of well. G7.fl Depth to water; (54.95? Actual purge: b 4 V <br /> Depth to water: 5.65 <br /> Start purge: ?5-5 Sampling time: 015 <br /> Time Temp. E. C. pH Turbidity Volume <br /> ------------ <br /> 56 1L 7CG <br /> 10.3- C_ ��� �z� 3 <br /> �fDJ? 6Y.5 ) 3 63 72-6 <br /> Sample appearance: 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: 9/16 Bolt: <br /> 6" Locking Cap: Pinned Allenhead (DWP) : <br /> . Remarks: <br /> Signature: <br />