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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date:_ /0'i� '9� <br /> Site: Beacon 513 Project No. :- 94-513-01 <br /> 401 W. Kettleman Ln. Well Designation: mw-3 <br /> Lodi, CA <br /> Is setup of traffic control devices required? YES time: hours <br /> Is there standing water in well box? IN 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" UV 12" UV 12" EMCO 8" BK <br /> 12" BK 12" DWP 12" CNI 36" CNI Other <br /> General condition of wellhead assembly: Excellent � o� 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" 6" 8" <br /> Purge Vol. Multiplier: 0. 16 0. 65 1. 47 2 . 61 gal/ft. <br /> Initial Measurement Recharge Measurement <br /> Time: E 0378.9 c,> Time:-(, 157 Calculated purge: <br /> `,Depth of well: ?r,J{ Depth to water: 6 7, 11 Actual purge: 1 <br /> Depth to water: 6 7/3 <br /> Start purge: Sampling time: 6Ih <br /> Time Temp. E.C. pH Turbidity Volume <br /> 6Gi5 7D. 7 761 - 1 <br /> 76 -7 74Ya <br /> Oa710 60 3 <br /> 63S 74, W 76s <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 /> Remarks: <br /> Signature: <br /> r <br />