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MONITORING WELL SAMPLING INFORMATION SHEET Ina <br /> Client: Lo� 't' Project No: W7LIo-00 <br /> Site: 2-(psco P0L* .L . &A_ Well Designation: MA-3 <br /> Is setup of traffic control devices required? YES Setup&Takedown time: hours <br /> Is there standing water in well box? NO YES (Above TOC Below TOC) <br /> Is Top of Casing out level? Nu £S (If NO please explain in remarks) <br /> Is well cap sealed and locked? NO jt (If NO please explain in remarks) <br /> Height of Well Casing AIser(In inches) <br /> General condition of Wellhead assembly cellent 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" 3" 4" 6" 8" <br /> Purge Vol. Multiplier: 0.163 0.367 0.653 1.47 2.61 gaUft. <br /> Time: ��G Time: Calculated purge: <br /> Depth of well: �_ Depth to water: Actual purge: <br /> th to water:l L t } -� <br /> Start purge: Sampling time; nq4o Sampling Date: -IL& q <br /> Time Temp E.C. pH Turbidity O (ppm) Volume (Gal.) <br /> Sample appearance: CLOUb4 <br /> OC samples collected at this well: t4o 0 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 />