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1GR0' <br /> f <br /> MONITORING WELL SAMPLING INFORMATION SHEET = <br /> mw <br /> Client: _ Project No: q_2A7� 11Y4&4 <br /> Site: y ZbpA= Well Designation: YY1t__, 1-- <br /> Tb <br /> is setup of traffic control devices reamed? ' YES Setup &Takedown tone: hours <br /> Is there standing water in wall box? NO YES (Above TOC Below TOC I <br /> Is Top of Casing cut level? NO { if No plane explain in remarks} <br /> Is wall cap sided and lockedl - NO ESQ ( If NO plows expia+n in remarks) <br /> Height of Well Casing Fuser ( in mchesl <br /> General condition of Wellhead assembly Excellent Co o d-) Fair Poor (Explain 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. r----- <br /> Well Diameter: 2" _ 3" 4" 6" 8" <br /> Purge Vol. Multiplier: 0.163 0.367 0.663 147 261 gal/ft. <br /> Initial MeasurmIn Recharge_Measurement <br /> Timer Time: 1 S a-a- Calculated purge: 3C? <br /> Depth of well: !E5q C, k Depth to water. A-4:a1 Actual purge:. " <br /> Depth to water: 4- Z3 <br /> 141er Calibration Temp. E.C. pH Turbidity <br /> 1e Initial reading <br /> Time Adjusted reading <br /> Start purge: 13 2Z Sampling time: 1 S _1S Sampling Date- <br /> Time Temp (IF) E.C. pH Turbidity OZ(ppm) Volume (Gal.) <br /> X33 "7S / 73g,s —76S 1 S 1 <br /> - 6 z-- -7•6-0 ; , <br /> 4q C) -7-7 K "169 10 <br /> Sample appearance: ; <br /> QC samples collected at this well: Lock: ()CI <br /> Equipment replaced: (Check all that apply) Note condition of replaced rtem. <br /> 2" Locking Cap: Lock #2357: Lock #0909: <br /> 4" Locking Cap: Lock #3753: 1 Lock-Dolphin:,! <br /> Remarks: <br /> 3ignetureC�,.n „(��. Review /ti <br />