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lu <br /> GRoJ <br /> MONITORING WELL SAMPLING INFORMATION SHEET ;w <br /> Client: Protect No: <br /> Site: {ops 5, �L LbpADo Well Designation: 1M k-,j - 1 <br /> _ <br /> 5T_rX4ThA1 CA . <br /> is setup of traffic control devices regwred? U YES Sattip &Takedown time: hours <br /> Is there standing water in wall box? NO! Y (Above TOC Below TOC ) <br /> Is Top of Casing cat level? NO Y i "NO please explain in remarks) <br /> is well cap sealed and locked? NO YES ( if No please wq*m in remarks) <br /> Height of Well Casing Riser ( in inches) _ <br /> General condkton of Wellhead assembly • Excellent Good Fair Poor (Exdain in ramariksl <br /> Purging Equipment: 2" Disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer <br /> Sampled with: Disposal bailer. X7 Teflon Bailer: r— <br /> Weil Diameter: 2" 3" _ 4" 6" _ 8" <br /> 4 Purge Vol. Multiplier: 0.763 0.367 0.653 147 2.61 gallft. <br /> r <br /> ` 1 <br /> Time: C\1- , Time <br /> Calculated purge: 1 <br /> Depth of well: ,4..,7�-� Depth to water:45.1 Z Actual purge: I <br /> Depth to water.. �}.'{- <br /> � <br /> Oer Calibration Temp. E.C. pH Turbidity <br /> Date_ )nodal reading <br /> Time Adjusted reading <br /> Start purge: E 2 Sampling time: 1 Sampling Date: 1 - 16 C1 <br /> Time Temp (°F) E.C. pH Turbidity Oztmm) Volume (Gal.) <br /> I 2,1E 6 4 ( 1 l 0"7,--s <br /> L3 � r ) locus S7 .� <br /> 1 ::i; 3 11 1 0 vs -7 4Y <br /> Sample appearance: C. Cxj d== <br /> QC samples collected at this well: Lock:,('-)6 QCT <br /> Equipment replaced: (Check allxhat apply) Note condmon of replaced rtem. <br /> 2" Locking Cap: Lock #2357: ,, Lock #0909: . <br /> 4" Locking Cap: Lock #3753: 1 Lock-Dolphin: II <br /> Remarks: <br /> rS7ignature '�� Review 4�L <br />