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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date:--d- 7-�J - <br /> • <br /> Site: Beacon #695 Project No. : 94-695-01 <br /> 900 S. Cherokee Lane Well Designation: MW- 2 <br /> Lodi CA <br /> Is setupof traffic control devices required? YES time: hours <br /> I ? Co YES Above TOC Below TOC <br /> Is there standing water in well box. <br /> Is top of casing cut level? NO <D If no, see remarks <br /> Is well cap sealed and locked? NO If no, see remarks <br /> Height of well casing riser (in inches) : 12}—EISCO g" BK <br /> Well cover type: 8" UV 12" W <br /> 12" BK 12" DWP_ - 12" CNI 36" CNI ther <br /> General condition of wellhead assembly: Excellent Goo 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:_,Y� Teflon bailer: <br /> Well Diameter: 211 -y 4" 6" 8" <br /> Purge Vol. Multiplier: 0. 16 0. 65 1. 47 2 . 61 gal/ft. <br /> Initial Measurement Recharge Measurement <br /> Time: / Time: LEIS Calculated purge; <br /> Depth of well: 70 Depth to water; 66 75 Actual purge:_•= 'j <br /> Depth to water: EG N <br /> Start purge: Sampling time: <br /> 410 <br /> Time Temp. E. C. pH Turbidity Volume <br /> .3ofs 762. L 1 6-L � <br /> �0 A/9rL 7 <br /> 3 / 1) 3 '7s-r 3 <br /> 31g 6F J/3 750 <br /> Sample appearance: rte- 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 /> • <br /> Remarks: <br /> Signature: <br />