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MONITORING WELL SAMPLING INFORMATION SHEET <br /> Client: Lo lZ k&LEW Project No: W7L&-moo <br /> Site: ?—foSro 000. --L k& Well Designation: M'4-) <br /> L <br /> Is setup of traffic control devices required YES Setup&Takedown time, hours <br /> Is there standing water in well boxy O Y.ES�' (Above TOC Below TOC) <br /> Is Top of Casing cut level? NCSY (if NO please explain in remarks) <br /> Is well cap sealed and locked? NO ES (if NO please explain in remarks) <br /> Height of Well Casing Riser( in inches) <br /> General condition of Wellhead assembly Exceilent Good 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: X Teflon Bailer: <br /> Well Diameter: 2" K 3" 4" 6" 8" <br /> Purge Vol. Multiplier: 0.163 0.367 0.663 1.47 2.61 gaUft <br /> Initial e t Recharge Meas cement <br /> Time: 0 mac' Time: Calculated purge: _) <br /> Depth of well: • Depth to water: Actual purge: <br /> th to water:P- 2 <br /> Start purge:n~74' Sampling time: Sampling Date: `1 0 tq <br /> Time Temp (4-) 1 E.C. pH Turbidity O (ppm) Volume (Gal.) <br /> Sample appearance: (-6 Lpv `� <br /> CC samples collected at this well: N,0 N L Lock: <br /> Equipment replaced: (Check all that apply) Note condition of replaced item. <br /> 2" Locking Cap: Lock#2357: Lock #0909: <br /> 3" Locking Cap: Lock#3753: Lock-Dolphin: <br /> 4" Locking Cap: Chevron Lock: <br /> Remarks: <br /> Ask <br /> qW II <br /> Signature Review <br />