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DODLOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date: 5'Z 7' <br /> • <br /> Site: Beacon #695 Pro]ect No. : 94-695-01 <br /> 900 -S. Cherokee Lane Well Designation: MW--2-1 <br /> Lodi CA <br /> Is setup of traffic control devices required? YES time: hours <br /> Is there standing water in well box? YES Above TOC Below TOC <br /> Is top of casing cut level? O UEPIf 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" UV12" LTV 12" EMCO 8" BK <br /> 12" BK 12" DWP_�C 12" CNI 36" CNI Other <br /> General condition of wellhead assembly: Excellent CooFair 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:_Z_ 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: 14— Time: 533 _ Calculated purge:_3 2 <br /> Depth of well-6f: ,6(� ___ Depth to water: C/,1. Q Actual purge: 3.2- n <br /> Depth to water:!Cj,r :5 <br /> Start purge: 06 Sampling time: 53q <br /> Time Temp. E. C. pH Turbidity Volume <br /> 56-7 70 6 1 <br /> 5/0 6 5`06- <br /> Lt <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 /> • <br /> Remarks: <br /> ,Signature. <br />