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C <br /> i <br /> H <br /> MONITORING WELL SAMPLING INFORMATION SHEET EM] <br /> Client: (p �Z Project No; '?i(o-V6 <br /> Site:22-6,5o tJpoELL eo&A Well Designation: ru.) Z_ <br /> Is setup of tEaffic control devices required' YES Setup&Takedown time: hours <br /> Is there standing water in well box? YES (Above TOC Below TOC) <br /> Is Top of Casing cut level? Nu Y (If NO please explain in remarks) <br /> Is well cap sealed and locked? NO Y (If NO please explain in remarks) <br /> Height of Well Casing Riser(in Inches) <br /> General condition of Wellhead assembly F.xcelle • Good 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: X Teflon Bailer: <br /> Well Diameter: 2" 3" 4" g" g" <br /> Purge Vol. Multiplier: 0.163 0.367 0.653 1.47 2.61 gala. <br /> Time: ? Time: Calculated purge: <br /> Depth of well: Depth to water: Actual purge: -41 <br /> 1knoth to water:[< <br /> tart purge: G"F<« Sampling time: (j Sampling Date: (q <br /> Time Temp (sF) I E.C. pH Turbidity O (ppm) Volume (Gal.) <br /> Sample appearance: <br /> CC samples collected at this well: No 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 /> Signature Review <br />