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GRO <br /> I <br /> MONITORING WELL SAMPLING INFORMATION SHEET f I <br /> �1 <br /> Client: Project Na: 7- f D4 <br /> Site: D0 Well Designation: mL� <br /> ' 7D <br /> is setup of traffic control devices required? i YES Setup &Takedown time: hours <br /> Is there standing water m wall box? 0JFES <br /> (Above TOC Below TOC ) <br /> Is Top of Casmg cut level? NO ( If NO please mmiam m remarks) <br /> Is wait cap sealed and locked? NO ( If NO please axpiam in rernarks) <br /> Height of Wel[Casmg Riser ( m inches) <br /> General condition of Wellhead assembly Exceilent o Fair poor (Exaiarn 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: <br /> Well Diameter. 2" _ 3" 4" 6" 8" _ <br /> Purge Vol. Multiplier. 0.163 0.367 0.653 147 261 gailft. <br />_Initial Measurment <br /> Time: \0 :�O Time:_1 S 42 Calculated purge: G <br /> IDepth of well: S Depth to water. 4--AciO Actual purge: <br /> Depth to water. <br /> r Calibration Temp. E.C. pH Turbidity <br /> e Initial reading <br /> TimeAdjusted reading <br /> Start purge: , 4- S O Sampling time: t S AS Sampling Date: 1 <br /> Time Temp (°F) E.C. pH Turbidity Or.(ppm) Volume (Gal.) <br /> 1SOZ char 11lovs <br /> � 5 I °I �5 i � ( � o1s � • � 2 � � <br /> Sample appearance: <br /> QC samples collected at this well: Lock: Q C <br /> quipment replaced: (Check all that apply) Note condition of replaced nem. <br /> 2" Locking Cap: Lock 12-357: , Lock #0609: <br />�." Locking Cap: Lock #3753: , Lock-Dolphin: <br /> Remarks: <br /> signature '� -� �-,, Review �-- <br />