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Aam EMEC AR,Ram SAMPLING INFORMATION SHEET <br /> Client: Project No: Z� <br /> Site:,�pa ST. CNK C.�o Well Designation: Ivy w — i <br /> _Is setup of traffic control devices requkred? l YES Setup &Takedown time: hours <br /> Is there standing water in well box? NO ffES=:1 (Above TOC a ow TO ) <br /> Is Top of Casmg cut level? No Cyp ( If NO please catonahe fis Miunksl <br /> Is well cap sealed and locked? NO YES: ( If NO please explain in remarksl <br /> Height of Well Casmg Riser ( in inchesl -3 <br /> General condition of Wellhead assembly Exceilent Good 4fasr Poor (Explain in remarks) <br /> Purging Equipment: Y_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" )L- 3" 4" 6" S" <br /> Purge Vol. Multiplier: 0 163 0 367 0.653 147 2.61 gal/ft <br /> Recharge Measurement <br /> rime: 0'9 Time Calculated purge: <br /> Depth of well: `7 0 `I v Depth to water: Actual purge: �-- <br /> Depth to water: (,, 7 <br /> b <br /> ter Calibration Temp. E.C. pH Turbidity <br /> e Initial Peading <br /> Time Adlumad vaeding <br /> Stab panrgG: 11 a Sampling time: I Y Y- i <br /> z Sampling Date: r (? <br /> I <br /> Time Temp. E.0 pH Turbidity Volume <br /> rd �� ��' < '� "� 33 <br /> Sample appearance: --C <br /> QC samples collected at this well: - - Lock: 7 r <br /> Equipment replaced: (Check all that apply) Note condition of replaced item. <br /> 2" locking Cap: C Lock #2357• U Lock #0909: C <br /> 4" Locking Cap: Lock #3753: Lock-Dolphin: <br /> Remarks: <br /> Signature Review <br />