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{ GRQ+ <br /> I <br /> MONITORING WELL SAMPLING INFORMATION SHEET i <br /> ' Client: _ Project No: �3tf'7 jy <br /> Site: Well Designation: YY-)1.k1•--7 <br /> T77 <br /> Is setup of traffic control devices required? n�NO E5 Setup &Takedowtone: hours <br /> is there standing water m well box? YES (Above TOC Below TOC ) <br /> Is Top of Casing cart level? NO (� ( if NO please explain in remarks) <br /> F Is well <br /> cap sealed and locked? NO ( it NO please explain in remarks) <br /> Height of Well Casing Fuser ( in inches} <br /> General condition of Wellhead assembly Excellent Farr 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. 7 Teflon Bailer r� <br /> Well Diameter: 2" 3" _ 441 X 6" g" <br /> Purge Vol. Multiplier. 0.163 0.367 0.653 147 2.61 gallft. <br /> _ ramal Measurment RechArce Measurement <br /> Time:\0 Time: 14475 Calculated purge: <br /> Depth of well: SQ . S�( Depth to water.-A :� Actual purge: <br /> —77 <br /> Depth to water. ::4, Irj <br /> Ier Calibration Temp. E.C. pH Turbidity <br /> ate initial reading <br /> Time Adjusted reading <br /> Start purge: j )-S Sampling time: 4 Sampling Date: l k– t <br /> Time Temp ff) E.C. pH Turbidity OZ tppm) Volume (Gal.) <br /> 4 <br /> 1 103 Ly,70 1 ,129 S'-cam- 1 � <br /> Sample appearance C , ,..(�� <br /> QC samples collected at this well: - Lock: crlc(oq <br /> Equipment replaced: (Check all that apply) Nate condition of replaced rtem. . <br /> 2" Locking Cap: = Lock #2357: , <br /> Lock #0909: <br /> 4" Locking Cap: Lock 13753: �-7 Lock-Dolphin:.I <br /> Remarks: �4 <br />,ignature Review <br />