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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date: 5- 7' 7 <br /> Site:, Beacon #695 Project No. : <br /> 94-695-01 <br /> 900 S. Cherokee Lane Well Designation: MW- <br /> Lodi , CA <br /> Is setup of traffic control devices required? YES time: hours <br /> Is there standing water in well box? 2 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: 8" UV12+' 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 J Centrifugal pump <br /> Sampled with: Disposal bailer: Teflon 4+f 6++ bailer: <br /> ++ <br /> Well Diameter: 2+' 8 <br /> • Purge Vol. ]Multiplier: 0. 16 0. 65 1. 47 2 . 61 gal/ft. <br /> Initial Measurement Recharge Measurement <br /> Time: /q7 _ Time: 6/S Calculated purge: /�� <br /> Depth of well: 6147? Depth to water: C3 2- 1 Actual purge: L zl <br /> Depth to water: 63 .L5 <br /> Start purge: 6014 Sampling time:, 6 / 6 <br /> Time Temp. E. C. pH Turbidity Volume <br /> 605 Q LI <br /> ,1117 <br /> 6dam 73 3 <br /> J 31 <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: 9/36 Bolt: <br /> 61+ Locking Cap: Pinned Allenhead (DWP) : <br /> Remarks: <br /> Signature: <br />