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GRO <br /> MONITORING WELL SAMPLING INFORMATION SHEET <br /> Client: _ Project No: <br /> Site: ) 5. �� jbkgZ�p Well Designation: rY) — 1 <br /> T77 <br /> Is setup of traffic control devices required? FNO <br /> YES Setup &Takedown time- hours <br /> Is there Staanding water in well box? Y (Above TOC Selow TOC ) <br /> Is Top of Casing cut level? NOY <br /> ra ( If NO please explain in remarks) <br /> Is well p sealed and locked? NO YES ( If NO please explain in remarks) <br /> Height of Well Casing Riser ( in inches <br /> General condipon of Wellhead assembly Excellent Good Feer Poor (&aiam 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. X Teflon Bailer: <br /> Well Diameter: 2" 3" 4" 6" 8" _ <br /> t <br /> Purge Vol. Multipher- 0 163 0.367 0 653 147 261 gal/ft <br /> ' Initial Measurment Recharoe Measurement <br /> Time: 1C2 � I_ Time: 1 S�; 0— Calculated purge: t <br /> Depth of well: Depth v7�- Depth to water. Actual purge: 4 <br /> Depth to water: 4- + <br /> t � <br /> t <br /> r Calibration Temp. E.C. pH Turbidity <br /> Initial reading <br /> Time Adjusted reading <br /> Start purge: 1 2 l Sampling time: Sampling Date• <br /> Time Temp (°F) E.C. 1 pH Turbidity 01(ppm) Volume (Gal.) <br /> I ZEE 64 f 1 l 0-7-"S <br /> i I to 1--s -7 4F <br /> Sample appearance: 0,-,C1� <br /> QC samples collected at this well: Lock: <br /> Equipment replaced: (Check all,that apply) Note condition of replaced item. <br /> 2" Locking Cap: Lock #2-357- , <br /> - Lock #0909: <br /> 4" Locking Cap: Lock 93753: ,— Lock-Dolphin:t <br /> Remarks: <br /> �c�„n �,a, �= <br /> Signature Review <br />