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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date: <br /> • <br /> Site: Beacon #695 Pro3ect No. : 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? � YES Above TOC Below TOC <br /> Is top of casing cut level? NO If no, see remarks <br /> Is well cap sealed and locked? N4 E If no, see remarks <br /> Height of well casing riser (in inches) : <br /> Well cover type: 8" UV 12" W 12" EMCO 811 <br /> BK <br /> 12" BK 12" DWP_�. 12" CNI 36" CNI then <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: _ Teflon bailer: <br /> Well Diameter: 2" ✓1 4" 6" 8 � <br /> Purge Vol. Multiplier: 0. 16 0. 65 1. 47 2 . 61 gal/ft. <br /> Initial Measurement Recharge Measurement <br /> Time: 36 Time: 33�f — Calculated purge: 3.7 <br /> b Actual purge <br /> Depth of well• . L Depth to water: �. _, <br /> Depth to water: 6 U,tl b <br /> Start purge: 334 _ Sampling time: IL:S <br /> Time Temp. E.C. pH Turbidity Volume <br /> g 5 76L 76L <br /> 33 71A0 Z <br /> 3 <br /> 3c�i 6 "i,3 12o7 �� � L/ <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:r, <br /> 6" Lacking Cap: Pinned Allenhead (DWP) :� <br /> • <br /> Remarks: <br /> Signature: _ - <br />