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Ah 'doft, <br /> 1W 11%w <br /> MONITORING WELL SAMPLING INFORMATION SHEET ps <br /> GRt3 <br /> client:T-�gcD 7't�,,,uJG/T�VSF�QT Project No: 9(ay7- 090/ <br /> Site: 5 Well Designation: let-,.,- <br /> C�? <br /> Is setup of traffic control devices required? �N YES Setup & Takedown time: hours <br /> Is there standing water in well box? NO YES ( Above TOC Below TOC I <br /> r� <br /> Is Top of Casing cut level? NO If NO please explain in remarks) <br /> Is well cap ed ` odced NO YES I If NO please explain in remarks) <br /> Height of Wed Casing Riser( in in es) <br /> Generai condition of Wellhead assembly Excellent Good Fair Poor (Explain in remarks) <br /> Purging Equipment: 2" Disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer <br /> Sampled with: Disposal bailer. CM Teflon Bailer: ❑ <br /> Well Diameter 2" _ 3" _ 4" 6" _ 8" <br /> Purge Vol. Multiplier: 0.163 0.367 0.653 1.47 2.61 gal/ft. <br /> Initial Mewurment Recharge Measurement <br /> Time: �`I -t�I Time: Calculated purge: j > <br /> epth of well: C Depth to water: Actual purge: <br /> pth to water I C 3 <br /> Start purge: 5 Sampling time: (DI Sampling Date: I,:� <br /> Time Temp <br /> 21\F)J E.C. pH Turbidity 02 (ppm) Volume (Gal.) <br /> Sample appearance: <br /> QC samples collected at this well: ��,c Lock: ,z <br /> Equipment replaced: (Check all that apply) Note condition of replaced item. <br /> 2" Locking Cap: ❑ Lock #2357:❑ Lock #0909: ❑ <br /> 3" Locking Cap: ❑ Lack #3753:❑ Lock-Dolphin:❑ <br /> 4" Locking Cap: ❑ Chevron Lack: ❑ <br /> Remarks: <br /> 0 <br /> Signature r J Review <br />