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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date: <br /> • <br /> Site: Beacon #695 Project No. : 94-695-01 <br /> 900 S. Cherokee Lane Well Designation: MW-30 <br /> Lodi CA <br /> Is setup of traffic control devices required? YES time: hours <br /> Is there standing water in well box? a YES Above TOC Below TOC <br /> Is top of casing cut level? NO <M If no, see remarks <br /> Is well cap sealed and locked? NO <E If no, see remarks <br /> Height of well casing riser (in inches) : _—4 — <br /> Well cover type: 8" UV12" UV121f EMCO 8" Bi{ <br /> 12" BK 12" DWP 12" CNI Z 36" CNI ther <br /> General condition of wellhead assembly: Excellent rood 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" 4" 8� 6" of _ <br /> Purge Vol. Multiplier: 0. 16 0. 65 1. 47 2 . 61 gal/ft. <br /> • In Measurement Recharge MeasurementCalculated purge: 8 3 <br /> Time: 1-5 Time: <br /> Depth of well: . / Depth to water:_ 67,k y Actual purge: A ti <br /> Depth to water: 6S 51- <br /> start <br /> LStart purge: Sampling time: '735 <br /> Time Temp. E.C. pH Turbidity Volume <br /> bz a <br /> 6 <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 /> i <br /> Remarks: _ <br /> Signature: l <br />