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SAMPLING INFORMATION SHEET <br /> Client:_ jE&QAJ (�qjr Project No: Z- <br /> Site: Ctoo Well Designation: M w -- <br /> Is setup of traffic control devices requaed? 0 YES Setup&Takedown time: hours <br /> Is there standing water in well box? YES (Above TOC Below TOC ) <br /> Is Top of Casmg cut level? NO �fW' (If NO please explain In remarks) <br /> Is well cap sealed and locked? NO ( If NO please explain in remarks <br /> Height of Well Casing Riser I In inches) J `"-"" <br /> General condition of Wellhead assembly Excellent o Fan Poor (Explain In remarks <br /> Purging Equipment: TC 2" Disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer <br /> Sampled with: Disposal bailer: i= Teflon Bailer: <br /> Well Diameter- 2" _4 3" 4" 6" 8" <br /> Purge Vol. Multiplier: 0 163 0 367 0 653 147 2.61 gallft <br /> Time: 6 S Time: Calculated purge: j <br /> Depth of well: b Depth to water: Actual purge: <br /> Depth to water- 6 7 0,- <br /> Nl@ter Calibration Temp. E.C. pH Turbidity <br /> Initial reading 9 <br /> Time Adjusted rasding <br /> Start purge: /0 , 00 Sampiing time Sampling Date: <br /> Time Temp. E.C. pH fTurbidity Volume <br /> it) rt� � � J -7r <br /> Sample appeeffance: r c;)O l _ c G 0 v,O <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 dock #0909: <br /> 4" Locking Cap: F--1 Lock #3753: Lock-Dolphin: <br /> Remarks: o`r rZ+)L"A fibo <br /> Signature Review <br /> i <br />