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DOOLOS ENVIRONitENTAL CORNY SAMPLIke INFORMATION SHEET <br /> Client: Ultramar Sampling Date: l-1x.-95 <br /> *Nw, 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? O YES time: hours <br /> Is there standing water in well box? O 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 ME If no, see remarks <br /> Height of well casing riser (in inches) • _ 4 <br /> Well cover type: 8" W 12" W 12" EMCO 8" BK <br /> 1211 BK 12" DWP 12" CNI 36" CNI Other <br /> General condition assembly:�Exce11�` oo Fair Poor <br /> Purging Equipment: 2" disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer ,4 Centrifugal pump <br /> Sampled with: Disposal bailer:—.X— Teflon bailer: <br /> Well Diameter: 2" 411 4 - 611 811 <br /> Purge Vol. Multiplier: 0. 16 0. 65 1.47 2 . 61 gal/ft. <br /> Tnitial Measurement Recharge Measurement <br /> ie:_ 41 Time:_ Oil Calculated purge: <br /> * th of well:_ .q6 Depth to water: 6 Actual purge: 37,5 2 <br /> Depth to water: _6 k.5-S <br /> Start purge: 1000 _ Sampling time: /(1O . <br /> Time Temp. E.C. pH Turbidity Volume <br /> I D 0d S71-7 IS L <br /> 71492 <br /> t <br /> Sample appearance: _� _ Lock: 1Lt4'� <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 2" Locking Cap: Lock 13753 : 7/32 Allenhead: <br /> 4" Locking Cap: Lock-Dolphin: 9/16 Bolt: <br /> 6" Locking Cap: Pinned Allenhead (DWP) : <br /> emarks: <br /> Signature: <br />