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r <br /> G RO <br /> MONITORING WELL SAMPLING INFORMATION SHEET i <br /> r <br /> Client: Project No: 83'47- jD4q _ <br /> Site: ZbpqpoWell Designation: M W 5rt>CJ=Al CA <br /> Is setup of traffic control devices required? _ ES J Setup &Takedown time: hours <br /> Is there standing water in well box? Y (Above TOC Below TQC I <br /> Is Top of Casing cut level? NO G ( If NO Pieria explain in remarks) <br /> Is well cap sealed and locked? NO Y '✓ ( If NO please explera in remarks) <br /> Haight of Wall Cssmg Riser( in inches) <br /> General condfoon of Wellhead assembly • Excellent Go Fair Poor (Ezolain m remarksl <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: F_ <br /> Well Diameter: 2" 3" 4" V_ 6" 8" <br /> Purge Vol. Multiplier 0.163 0.367 0.653 1.47 2.61 gallft. <br /> Initial Measurment Recharce Measurement <br /> Time: "]_C- Time: Calculated purge: <br />!Depthr of well: S - Depth to water. Actual purge: <br /> Depth to water.Wr Caiibration Temp. E.C. pH Turbidity <br /> Date Initial reading <br /> Time Adjusted reading <br /> Start purge: S Sampling time: 117C.CD Sampling Date:Time Temp (QF) E.C. pH Turbidity O7.(ppm) Volume (Gal.) <br /> 1413 -763 ao <br /> �4 I (A,- M5 6,3 <br /> Sample appearance: <br /> QC samples collected at this well: Lock: CSG Oc{ <br /> Equipment replaced: (Check all that apply) Note condition of replaced item. <br />?" Locking Cap: Lock #M57: , <br /> Lock #0909: � 3 <br /> Locking Cap: Lock #3753: ,— Lock-Dolphin: I <br />�Rema�rks: <br /> ignature 1��G� .u, Review ry <br />