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SAMPLING INFORMATION SHEET <br /> Client: Project No: <br /> —3---733 <br /> Site: _ i�D 5. Cfflg141a�. ZR, Well Designation: <br /> Is setup of traffic corral devises required? YES Setup &Takedown time: (hours <br /> Is there standing water in well box? IND YES (Above TOC Below TOC) <br /> Is Top of Casing cut level? NOESS {If NO please explain in remarks) <br /> Is well cap sealed and kicked? : O -4m (if NO please explabr in remarks) <br /> Height of Well Camng Riser(In inches) <br /> 1— <br /> General condition of Wellhead assembly Exceiient Fair Poor (Expiain In remarks) <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" 3" 4" fi" 8" <br /> Purge Vol. Multiplier: 0.163 0.367 0 653 1.47 2.61 gal/ft <br /> Recharoe Measurement <br /> Time: 47 ye) Time: Calculated purge: <br /> Depth of well: ? 6 l d Depth to water: Actual pure®: <br /> Depth to water:& o <br /> ter Calibration Temp. E.C. pH Turbidity <br /> e lnWal reading <br /> Time AQ=aid treading <br /> Stara purge: 3 Yd Sampling time: r /0 Sampling Date: /:,t <br /> Time Temp. E.C. pH Turbidity Volume <br /> 13 = �� 3 6 YY <br /> 5 � 3 • �� S'? 76Y <br /> 5 a3 7G055- <br /> Sample appearance- C, L 84 �- <br /> QC samples collected at this well: Lock: 3 7j '-?, <br /> Equipment replaced: (Check all that apply► Note condition of replaced stem. <br /> 2" Locking Cap: =Ulpr' Lock #2357: Lock #0909: 0 <br /> 4" locking Cap: F! Lock #3753: Lock-Dolphin: <br /> Remarks: G p tiA Lei c A LN i T z 6 fd t<-vu <br /> Z>s. <br /> Signature �' Review <br />