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r <br /> DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date: 7-)-1-2 —. <br /> Site: Beacon#513 Project No.: 94-513.01 <br /> 401 W.Kettleman Lane Well Designation: mw-3 <br /> Lodi,CA <br /> Is setup of traffic control devices required? 1 YES time: hours <br /> Is there standing water in well box? YES Above TOC Below TOC <br /> Is top of casing cut level? NO S Lf no,see remarks <br /> Is well cap sealed and locked? NO If no,see remarks <br /> Height of well casing riser(in inches): I <br /> Well cover type: 8"UV 12"LJV 12" EMCO 8"BK <br /> 12"BK 12"DPW 12" CNI 36" CNI Other <br /> t General condition of wellhead assembly: Excellent Good Fair Poor <br /> Purging Equipment: 2" disposable bailer Submersible pump <br /> 3"PVC bailer Dedicated bailer <br /> 4"PVC bailer Centrifugal pump <br /> Sampled with: Disposable bailer: Teflon bailer: <br /> Well diameter: 2"T 4" 6" 8" <br /> Purge Vol. Multiplier: 0.16 X0.65 1.47 2.61 gavft <br /> Initial Measurement Recharge Measurement <br /> Time: �;q r7 __ Time: <br /> 7�=� Calculated purge:3 teZ4_ <br /> Depth of well: D 1 Depth to water: 619V.Q Actual purge: 3 �,i <br /> Depth to water: 6 . <br /> Start purge: -7 Sampling time: -75- 5- <br /> Time <br /> 5- STime Temperature E. C. pH Turbidity Volume <br /> � ' � ? 7� <br /> Sample appearance: Lock: ...�- <br /> Equipment replaced: (Check all that apply) Note condition of replaced items <br /> 2" locking cap: Lock#3753: 7/32 Allenhead: <br /> 4" locking cap: Lock-Dolphin: 9/16 bolt: <br /> 6" locking cap: Pinned Allenhead(DPW): <br /> Remarks: <br /> Signature: <br /> f <br />