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ASME MUM.MM SAMPLING INFORMATION SHEET <br /> 40 <br /> Client:_ � .� �qS _ Project No: <br /> 5 / <br /> _ 9Z�"� /�3 <br /> Site: �V� <br /> • ( ��W�� LAI. {fv Well Designation: - es w <br /> Is setup of traffic control devices required? I10 YES Setup&Takedown time: hours <br /> Is there standing water in well box? CN_OY (Above TOG Below TOC <br /> Is Top of Casing cut level? - NO 459 ( If NO please explain in remarks) <br /> Is well cap sealed and locked? NO [6E9 { N NO please explain in rarnarks) <br /> Height of Well Casuig Riser i in inches) ,'� <br /> Genwal condition of Wellhead assembly Excellent ({oo�l Fair Poor (Expialn 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- 7� Teflon Bailer: <br /> Well Diameter- 2" -Y,- 3" _ 4" 6" S" <br /> Purge Vol. Multiplier- 0.163 0 367 0 653 147 2.61 gal/ft <br /> Initial _Reghargp,measurement <br /> Time:_9_17�g s" S Time Calculated purge: 9%,Depth of well: 1 cj Depth to water: Actual purge: 2 <br /> Depth to water: I <br /> Wr Calibration Temp E.C. pH Turbidity <br /> Initial reading <br /> Time Adjusted vaccO tg <br /> Stars pupge: �{ Sampling time / " 3a Sampling Date: ���r 7 y <br /> Time Temp. E C. pH Turbidity Volume <br /> Sample appearance: L 6 O U L1 ;' - Y �'c v�✓ : {-�`- • <br /> QC samples collected at this well: Lock: 3 7 J <br /> Equipment replaced: (Check all that apply) Note condition of replaced Item. <br /> 2" Locking Cap: C Lock #2357 C Lock #0909: C] <br /> 4" Locking Cap- F-1 Lock #3753• r---- Lock-Dolphin: <br /> Remarks: _ S.LOU-)_ J GC H A!z6 6- .._.._._ <br /> Signature �;�'��`1 Review <br />