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GR0 <br /> �MONPT MG WELL, SAMPLING INFORMATION SHEET <br /> Client: Project No: q,747- IM <br /> Site: Well Designation: v,n w- 12- <br /> 13 <br /> Is setup of traffic control devices required7 NQ YES Setup &Takedown trine. hours <br /> Is there standing water in well box? NO YES (Above TOC Below TQC } "x <br /> Is Top of Casing cut level? No { It NO please axp(arn in remarks) , <br /> Is well cap sealed and locked? NO YE ( If No please explam in rarnarksl <br /> Height of well Casing Riser( in incnesl - <br /> General condition of Wellhead assembly Excellent Good) Eayr - "Z Poor (Exdain in rernwks) <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-Well Diameter: 2" 3" 4" X 6" 8" <br /> Purge Vol. Multiplier- 0 163 0.367 0 653 1 47 2.61 gal/ft <br /> 4 <br /> Initial Measurment Recharee Measurement r <br /> Time: 10 l L— Time: Calculated purge: <br /> Depth of well: S CAn Depth to water. Actual purge: <br /> Depth to water: <br /> 4-4 <br /> ter Calibration Temp. E.C. pH Turbidity <br /> to Inniai reading <br /> Time Adjusted reading <br /> Start purge: Z•Ll I Sampling time: 1 ,54A Sampling Date: k -XL, -C,Z <br /> Time Temp (°F) E.C. I pH Turbidity 07,(ppm) Volume (Gala <br /> ► 15 3►)s 1 .,3 Yj <br /> L S� 6 S 1 Sri ,s `7' Sal <br /> Sample appearance: C�ec�c� <br /> QC samples collected at this well: Lock: ;C( <br /> Equipment replaced: (Check all that apply) Note condition of replaced nern. <br /> 2" Locking Cap: _' Lock #2357: , Lock #0909: <br /> 4" Locking Cap: Lock #3753: ,— Lock-Dolphin:�€ <br /> Remarks: <br /> Signature , Review <br />