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V <br /> DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date: `:moi <br /> • <br /> Site: Beacon 695 Pro3ect No. : 94-695-01 <br /> 900 S. Cherokee Lane Well Designation: MW- j <br /> Lodi CA <br /> Is setup of traffic control devices required? YES time: hours <br /> Is there standing water an 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 !U]�q If no, see remarks <br /> Height of well casing riser (in inches) : �� <br /> Well cover type: 8" UV12" UV 12" EMCO 8 BK <br /> 12" BK 12" DWP 12" CNIX� 36" CNI Other <br /> General condition of wellhead assembly: Excellent Good ai Poor <br /> Purging Equipment: . 21, disposable bailer Submersible pump <br /> 211 PVC bailer Dedicated bailer <br /> 4" PVC bailer - Centrifugal pump <br /> Sampled with: Disposal bailer:_ Teflon bailer:- <br /> Well <br /> ailer:Well Diameter: 211 01 611 811 <br /> Purge Vol. Multiplier: 0. 16 0 . 65 1. 47 2 . 61 gal/ft. <br /> Initial Measurement Rechar a Measurement <br /> Time:_ 2-4-9 Time: /0-z- Calculated purge: D <br /> Depth of well: l _ Depth to water: F o Actual purge: <br /> Depth to water:, 65 1 <br /> Start purge: � Sampling time: 0 2 S <br /> Time Temp. E.C. pH Turbidity Volume <br /> V 7 <br /> 03 17Y <br /> Sample appearance: r 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:�1 9/16 Bolts <br /> 6" Locking Cap: Panned Allenhead (DWP) : <br /> i <br /> Remarks: <br /> Signature: <br />