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GRA <br /> f <br /> MONITORING WELL SAMPLING INFORMATION SHEET <br /> Client:? -xAcn �Gfp,► IG `T�4AlSfb,eT Project No: <br /> Site: �tIWWA/ E�yTr?�2�SCS Well Designation: L-�LLL - iL <br /> .Q Cf>t <br /> Is setup of traffic control devices required? YES Setup &Takedown time: hours <br /> Is there standing water in well box? N0 YES ( Above TOC Below TOC 1 <br /> Is Top of Casing cut level? NO ES , ( If NO please explain in remarks) <br /> Is well cap sealed and locked? NQ YES f If NO please explain in remarks) <br /> Height of Well Casing Riser ( in inches) iS <br /> General condition of Wellhead assembly Excellent /"Good Fair Poor (Explain in remarks) <br /> Purging Equipment: 2" Disposable-b—A ier Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer <br /> Sampled with: Disposal bailer: ❑ Teflon Bailer: ❑ <br /> Well Diameter 2"Ys 3" _ 4" _ 6" _ 8" _ <br /> Purge Vol. Multiplier. 0.163 0.367 0.653 1.47 2.61 gal/ft. <br /> Initial Measurment Recharge Measurement <br /> Time:-GC, �� Time: Calculated purge: L <br /> epth of well: , 1 Depth to water: Actual purge: Z <br /> pth to water:t�, I <br /> Start purge: ct I C Sampling time: `%C 77 Sampling Date: of <br /> Time Temp ( F) E-C. pH Turbidity Oz (ppm) Volume (Gal.) <br /> Ll <br /> Sample appearance: <br /> QC samples collected at this well: Lock: <br /> Equipment replaced: (Check all that apply) Note condition or replaced item. <br /> 2" Locking Cap: ❑ Lock 102357: ❑ Lock 40909: ❑ <br /> 3" Locking Cap: Q Lock x#3753:17 Lock-Dolphin:❑ <br /> 4" Locking Cap: ❑ Chevron Lock: ❑ <br /> Remarks: <br /> �"� � i. �r-�a`�,� �-'�' I �-- ,ti'•t�i Lam, (�, �c r STt,.:i �:.c.'Ci�`l� <br /> it <br /> Signature Review �, <br />