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L4A46AlkC. SAMPLING INFORMATION SHEET <br /> Client: Jgi5,¢�A[ - 'fpq� _ Project No: <br /> Site: ZY&IS .— Ws 1&AZZ7[.96YAAZ_ Well Designation: _ <br /> LDlb! - - - C4, - - _ <br /> Is setup of traffic control devices required? . NO YES Setup &Takedown time: hours <br /> Is there standing water in well box? . NO YES ( Above TOC Below TOC ) <br /> Is Top of Casing cut level? . NO YES I If NO please explain in rernarks) <br /> Is well cep sealed and locked? . NO YES I If NO piease explain in remarks] <br /> Height of Well Casing Risar( in inches) <br /> General condition of Wellhead assembly Excellent 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: �. Teflon Bailer: �– <br /> Well Diameter: 2" 3" 4" fi" 8" <br /> Purge Vol. Multiplier: 0.163 0.367 0.653 1.47 2.61 galift. <br /> Initial MenlirMjnt RgchArae Measurement <br /> Time: Time: Calculated purge: <br /> Depth of well: Depth to water: Actual purge: <br /> Depth to water: <br /> Fter Calibration Temp. E.C. pH Turbidity <br /> o Initial reading <br /> e Adjusted reading <br /> Start purge: Sampling time: ate: <br /> Time Temp. E.C. pH Turbidity Volume <br /> Sample appearance: <br /> QC samples collected at this well: Lock: <br /> Equipment replaced: (Check all that apply) Note condition of replaced item. <br /> 2" Locking Cap: C Lock #2357: 0 Lock #0909: J <br /> 4" Locking Cap: Lock #3753: 1 Lock-Dolphin. <br /> Remarks: <br /> D.�. Wf#TEf� <br /> Signature Review <br />