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I <br /> Ak <br /> G o <br /> MONITORING WELL SAMPLING INFORMATION SHEET <br /> Client:7-,I-y,4 12,0pA/6 /7-)W6,vaR7- Project No: 977- 090/ <br /> Site: Well Designation: Z�� - <br /> T C� <br /> Is setup of traffic control devices required? NO YES Setup &Takedown time: hours <br /> Is there standing water in wed box? NO YES ( Above TOC Below TOC ) <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 WeWwad assembiy 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. ❑ Teflon Bailer: ❑ <br /> Well Diameter 2" _ 3" _ 4" � 6" <br /> Purge Vol. Multiplier: 0.163 0.367 0.653 1.47 2.61 gai/ft. <br /> Initial Measurment Recharae Measurement <br /> Time: Time: Calculated purge: <br /> Depth 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 O (ppm) Volume (Gal.) <br /> Sample appearance: <br /> QC samples collected at this well: Lock: <br /> Equipment replaced: (Check all that apply) Note condition of replaced item. <br /> 2" Locking Cap: ❑ Lock #2357: ❑ Lock #0909: ❑ <br /> 3" Locking Cap: F7Lock #3753T7 Lock-Dolphin:❑ <br /> 4" Locking Cap: Q Chevron Lock: ❑ <br /> r. <br /> Remarks: <br /> I'\ 1 <br /> Signature Review <br />