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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date: Ll 7'9 <br /> . Site: Beacon #695 Project No. : 94-695-01 <br /> 900 S. Cherokee Lane Well Designation: MW- 17 <br /> Lodi, CA <br /> Is setup of traffic control devices required? YES time: hours <br /> Is there standing water in well box? O 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) : - - 3 <br /> - <br /> Well cover type: 8" UV 12" UV 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: :,:L Teflon bailer: <br /> Well Diameter: 2" 4" 6" 8" <br /> Purge Vol. Multiplier: 0. 16 0. 65 1 . 47 2 . 61 gal/ft. <br /> . Initial Measurement Recharge Measurement_ <br /> Time: !i� / Time: q /3_ - Calculated purge: z <br /> Depth of well:_ C ci _5h Depth to water:_6 6 (0? Actual purge: 2-,5 & <br /> Depth to water: 6.5-,CU <br /> Start purge: Ss30 Sampling time: <br /> Time Temp. E. C. pH Turbidity Volume <br /> R'40 6 710 <br /> 705 <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 /> iG Remarks: <br /> Signature: �al Zwlv <br />