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IMPGROI <br /> MONITORIN <br /> G WELL SAMPLING INFORMATION SHEET <br /> Client: Project No: <br /> Site: )(,.05 5„e_e� DppA= Well Designation: ��.v <br /> T77C4TZ)Al QA . <br /> Is setup of traffic control devices required? N YES Setup&Takedown tame. hours <br /> is there standing water in well box? NO (Above TOC Below TOC ) <br /> Is Top of Casing cut level? NO f ( If NO please exptaen m remarks <br /> Is wait cap sealed and locked? NO (YE. i If NO please explain in remarks! <br /> Height of Well Casing Riser i in inches! <br /> General condition of Wellhead assembly Excellent GoodD 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. <br /> Well Diameter: 2" _ 3" 4" 6" 8" <br /> Purge Val. Multiplier- 0 163 0.367 0 663 147 2.61 gal/ft <br /> Initial M.P8,1 45 Aechar,ai` g41 ur.Cmgnt <br /> Time:O C1 65 Time: Calculated purge: <br /> Depth of well: S(l . C Depth to water: Actual purge: <br /> Depth to water: <br /> er Calibration Temp. E.C. pH Turbidity <br /> Date Inmal reading <br /> Time Adjusted reading <br /> Start purge: �I C-) *3% Sampling time: �cGC,G Sampling Date:.�_�- 1�,-��+ <br /> Time Temp (°F) E.C. pH Turbidity 07,(ppm) Volume (Gal.) <br /> E <br /> 0 ,5rvS.S t 4 \C us -7 q1 amid <br /> 1 D � _ &.o 1 Sous- 36z � <br /> Sample appearance: <br /> QC samples collected at this well: _Lock:�� O <br /> Equipment replaced: (Check all that apply) Note condmon of replaced Item. <br /> 2" Locking Cap: Lock #2357- , Lock #0909: . <br /> 4" Locking Cap: Lock #3753: ,— Lock-Dolphin:• <br /> Remarks: ID J(Z) (Y(S-71 I(--6L,- <br /> Signature <br /> ibL`Signature C Review <br />