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DOULOS ENVIRONMENTAL COFh",tNy SAMPLIb4 INFORMATION SHEET <br /> Client: Ultramar Sampling Date:_. 1-MLIS <br /> Site: Beacon 513 Project No. : 94-513-01 <br /> _ 441 W. Kettleman Ln. Well Designation: XW- <br /> Lodi, CA <br /> Is setup of traffic control devices required? (R-6 YES time: hours <br /> Is there standing water in well box? NO E Above TOC eello�Zkg C <br /> Is top of casing cut level? NO If no, sae r� <br /> Is well cap sealed and locked? NO E If no, see remarks <br /> Height of well casing riser (in inches) : 3 <br /> Well cover type: 8" UV12" UV )( 1211 EMCO g" BK <br /> 12" BK 12" DWP 12" CNI 36" CNI Other <br /> General) condition of wellhead assembly: lllent Goo 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: -Y— Teflon bailer: <br /> Well Diameter: 2" 41+�_ 611 811 <br /> Purge Vol. Multiplier: 0. 16 0. 65 1.47 2 . 61 gal/ft. <br /> Initial Measurement Recharge Measurement <br /> ne: q« Time: Calculated purge: 31 (� <br /> 'nVpth of well: 76.9 Depth to water: Actual purge: 31 b <br /> Depth to water: .CA1:�Z <br /> Start purge: 1? �Q Sampling time: 160 <br /> Time Temp. E.C. pH Turbidity Volume <br /> 3 9 <br /> 737 3 <br /> Sample appearance: Lock: <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 /> temarks: <br /> Signature: ! _ _ <br />