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-tOGR <br /> MONITORING WELL SAIMPLING INFORMATION SHEET ZI <br /> s� <br /> Client:T-xAcD Iz-#p t1G/73W6,p0g7- Project No: 97,77-y7- p-2D/ <br /> Site: 9t-AVWW E,yTt?P2�S�S Well Designation: <br /> ,¢ a <br /> Is setup of traffic control devices required? N YES Setup &Takedown time: hours <br /> Is there standing water in wed box? (-!0-/ YES.._, ( Above TOC Below TOC 1 <br /> Is Top of Casing cut level? NO, YES, ( If NO please explain in remarks) <br /> Is wed cap sealed and locked? NO YES ( If NO please explain in remarks) <br /> Height of Well Casing Riser ( in inches) <br /> General 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: 1771 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 Measurment Recharae Measurement <br /> Time: ( Time: Calculated purge: <br /> pth of well: Depth to water: Actual purge: <br /> pth to water: <br /> Start purge: Sampling time: Sampling Date: <br /> Time Temp ( F) E.C. pH Turbidity 0 (ppm) Volume (Gal.) <br /> Sample appearance: <br /> QC samples collected at this well:��_ Lock: <br /> Equipment replaced: (Check ail that apply) Note condition of replaced item. <br /> 2" Locking Cap: ❑ Lock #2357: Com_ Lack #0909: <br /> 3" Locking Cap: ❑ Lock #3753:❑ Lack-Dolphin:❑ <br /> 4" Locking Cap: Chevron Lock: ❑ <br /> Remarks: ;t L +� � , l.�C -l(= : i�L� <br /> �� G <br /> Signature <br /> Review <br /> MMMMA <br />