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' SAMPLING INFORMATION SHEET- <br /> Client: <br /> HEETClient: Ig Project No: <br /> Site: —CM j, C}jJz=g!0g Well Designation: /W U/- a <br /> Is setup of traffic control dram required? YES Setup &Takedown time: hours <br /> Is there standing water in wag box? Q l� YES (Above TOC Blow TOG } <br /> Is Top of Casing cut level? NO ( If NO please explain in remarks) <br /> Is wail cap ceded and locked? NO V0 [If NO please explain in remadmi <br /> Height of Weil Casing Riser(in inches) 92 <br /> General careftm of Wellhead assembly - )Excellent ® Poor (Explain in remarks) <br /> Purging Equipment: 2" Disposable bai er Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" IVC bailer <br /> Sampled with: Disposal bailer: 'teflon Basler: <br /> Well Diameter: 2" 3" 4" _ 6" 9" <br /> Purge Vol. Multiplier: 0.963 0.367 0 653 9.47 2.69 gal/ft <br /> 11311181 M118sun"en Recharge Measurement <br /> Time: �� S�S Time: Calculated purge: <br /> Depth of well: 7 Depth to water: Actual purge: <br /> Depth to water: S v <br /> eter Calibration Temp. E.C. pH Turbidity <br /> Initial reading " <br /> Time ad;=eel veading <br /> Start purge: Samplingtime: � 13 : J_5` Sampling Dat®: /,�T[ 9 <br /> ) <br /> Time Temp. E.C. pH Turbidity Volume <br /> 3L! 15 S �► s 7 �3 N <br /> Sample appearance: C L CA tL <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: C Lock #0909: <br /> 4" locking Cap: k Lock #3753: Lock-Dolphin: <br /> Remarks: S L04,J 2 c.u A 4 6 0 <br /> b,Z WATEZ <br /> Signature Review <br />