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, :DUFG R O JMONITORINGI <br /> M <br /> WELL SAMPLING INFORMATION SHEET ""' <br /> MM Me M <br /> Client: E _ Project No: <br /> Site: 005 �. eL Z rp � p0 Well Designation: Yy'\l,`I -- <br /> Ta <br /> Is setup of traifF,c control devices requw ? YES Setup &Takedown time: hours <br /> Is there standing water in well box? NO I Above TQC Reiow TOC ) <br /> is Top of Casing cut level? NOnYE <br /> ( If NO pieme explain in remarks) <br /> Is well cap sealed and locked? NO [ If NO please explain in remarks) <br /> Height of Well Casing Riser I in inches) <br /> General condition of Wellhead assembly Excellent Good) fair Poor (Fxalaen in remarks) <br /> Purging Equipment: 2" Disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> X 4" PVC bailer <br /> Sampled with: Disposal bailer. X� Teflon Bailer. r------ <br /> Weil Diameter: 2" 3" 4" 6" 8" <br /> Purge Vol. Multiplier: 0.163 0.367 0.653 1.47 2.61 gaflft <br /> I <br /> Time:0 CA 5 S Time: Calculated purge: <br /> Depth of well: Sq . O Depth to water. Actual purge: <br /> Depth to water: S <br /> t <br /> r Calibration Temp. E.C. pH Turbidity <br /> )nivel reading <br /> Time Adjusted reading <br /> Start purge: ( 5<- Sampling time: G Sampling Date:1 <br /> Time Temp (QF) E.C. pH Turbidity Oxlppm) Volume (Gal.) <br /> i U 150 <br /> Sample appearance: CJS-- A <br /> QC samples collected at this well: II <br /> _�ock: <br />:quipment repiaced: (Check all that apply{ Note condition of replaced item. <br />)" Locking Cap: Lock #2357: , Lock #0909: . <br /> t" Locking Cap: ' Lock #3753: Lock-Dolphin,,i <br /> Remarks: 01(,- hdT I�kt,' <br /> f <br /> i <br /> I <br /> i <br /> i <br />;ignature Review <br />