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1 . SAMPLING INFORMATION SHEET J)Ade, S)L <br /> Client:_ DA ��jr _ Project No: Za <br /> Site:_Cera f Well Designation: to <br /> _402W eg. <br /> Is setup of traffic control devices required? Y1:5 &Takedown time: haus <br /> Is there standing water in well boutd YES (Above TOC Below TOC) <br /> Is Top of Casing cut level? NO <1W ( If NO please explain in remarks) <br /> Is wail cap sealed and locked? NO ( If NO please explain in remarks) <br /> Height of Well Casing Riser(in inches) <br /> General condition of Wellhead assembly Excellent h Fair Poor (Explain in ranarksI <br /> Purging Equipment: �L 2" Disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC hailer <br /> Sampled with: Disposal bailer: Teflon Sailer- <br /> Well Diameter: 2" N 3" 4" 5" 8" <br /> Purge Vol. Multiplier* 0 163 0 367 0 553 147 2.61 gal/ft. <br /> larbaUdeasurment _Recilaroe_Measurement <br /> Time. 0 ? ;/8 Time Calculated purge: <br /> Depth of E _7, .7e5 Depth to water* Actual purge: <br /> Depth to water: <br /> bter Calibration Ternp ' E.C. pH Turbidity <br /> e Inatiail readrng <br /> Time Adjusted macUng <br /> Start purge: 11 00 Sampling time t Y aSampling Date: /,,1 //7 <br /> 11 <br /> Time Temp. E.C. pH Turbidity Volume <br /> (6 S"76 `'s -7 � <br /> i <br /> Sample appearance C_'?1-1 L d <br /> ®.0 samples collected at this well: Lock: <br /> Equipment replaced: (Check ail that apply) Note condition of replaced item. <br /> 2" Locking Cap: M Lock #2357 I Lock #0909: C] <br /> 4" Locking Cap: f Lock #3753. r--- Lock-Dolphin: &E <br /> Remarks:�: L L. c, �. �; �,. i„� r 11- 5 LO ��L'cNl4 G 4' <br /> S. WAT5Z - <br /> Signature Review <br />