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dal SAMPLING INFORMATION SHEET <br /> Client: Project No: Z X33 - <br /> Site: qDD 7 o Well Designation: Mw- <br /> 40b/ <br /> w-,tar e4. _ <br /> Is setup of traffic control devices required? N YES Setup $&Takedown dm* hours <br /> Is there stan" 9 water in well box? NO (Above TOC M�rmwnwpkWil <br /> Is Top of Casing cut ievel7 NO + [N NO please expldn <br /> Is wail cap sealed and locked? NO E' [ It NO please explain in remarksI <br /> Height of Wall Casmg Aisar i in inches) A ^ <br /> General condition of Wellhead assembly Exceuem Good t� poor Mxplein In rernarksl <br /> Purging Equipment: 2" Disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer <br /> Sampled with: Disposal bailer: Teflon Bailer: 0 <br /> Well Diameter: 2" 3L 3" _ 4" _ 6" 8" <br /> Purge Vol. Multiplier: 0.163 0 367 0.653 1.47 2.61 gallft. <br /> Innial Measuffnent Recharne Measurement <br /> Time: 07: / 7' Time• Calculated purge: <br /> Depth of well: '? O, S Depth to mater: Actual purge: <br /> Depth to water: 6 d a Sr <br /> ter Calibration Temp. E.C. pH Turbidity <br /> e Initial raading <br /> Time Adj=ad reeding <br /> Start purge: 10 - 3 Sampling time: / D Sampling Date: Id 1 <br /> Time Temp. E.C. pH Turbidity Volume <br /> Sample appearance: C L C4 A- <br /> aC samples collected at this well: Lock: 3 T <br /> Equipment replaced: (Check ail that apply) Note condition of replaced item. <br /> 2" Locking Cap: Lock #2357: = Lock #0909: 0 <br /> 4" Locking Cap: C Lock #3753: n Lock-Dolphin: <br /> Remarks: 5 LOW iLEL.N O R6 0 <br /> X, WMIEZ= <br />'Signature Review <br />