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Ad=2MWXQ4iPa SAMPLING INFORMATION SHEET <br /> Client: QkoAL - ��- Project No: 9Z- 7 <br /> Site: Z - Well Designation: 1,.) <br /> LDS J <br /> Is setup of traffic control devices required? rtid YES Setup&Takedown time: hours <br /> Is there standing water in well box? YES I Above TOC Below TOC ) <br /> Is Top of Casing cut level? NQY ( If NO please explain in remarks) <br /> Is well cap sealed and locked? : NO E ( If NO please explain in remarks) <br /> Height of Well Casing Riser I in inches) <br /> General condition of Wellhead assembly Excellent coz, Fair Poor (Explain in remarks) <br /> Purging Equipment: 2" Disposable bailer X _ Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer <br /> Sampled with: Disposal bailer: I Teflon Bailer: <br /> Well Diameter: 2" 3" 4" ,�L 6" g" <br /> Purge Vol. Multiplier: 0.163 0.367 0.653 1.47 2.61 gallft. <br /> Initial MeasurMeni _fecharae Measurement <br /> Time: ! Time:gyoA, Calculated purge: <br /> Depth of well: A .) Depth to water:_ Actual purge: <br /> Depth to water: <br /> tTimterCalibration Temp. E.C. pH Turbidity <br /> e Initial reading 6 ;e Adjusted reading `_ <br /> Start purge:_21 21L-1 Sampling time: Cjq�,I q. Sampling Date: <br /> Time Temp. E.C. pH 1 Turbidity Volume <br /> �- <br /> 10 <br /> Sample appearance: <br /> QC samples collected at this well: Lock:37S <br /> Equipment replaced: (Check all that apply) Note condition of replaced item. <br /> 2" Locking Cap: Lock #2357: C Lock #0909: !_ t <br /> 4" LockingCap: I� <br /> Lock #3753: Lock-Dolphin: I � <br /> Remarks: <br /> 7ignature <br /> U.JttTEE= (} Review <br /> tl <br />