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AAM SMEMMMAL.ONQ SAMPLING INFORMATION SHEET <br /> IF4 <br /> Client: * Project No: �- 7 <br /> Site: ��_y$_ gAU:r4.n.4-AJ Well Designation: s� y <br /> LDS/ <br /> T <br /> Is setup of traffic control devices required? YES Setup&Takedown time: hours <br /> Is there standing water in well box? o YES I Above TOC Below TOC <br /> Is Top of Casing cut ievai7 NO I If NO please explain in remarks) <br /> Is well trap sealed and iocked? NO E ( If NO please explain in remarks) <br /> Height of Well Casing Riser 1 in inches) <br /> General condition of Wellhead assembiy Excellent Fair Poor (Explain in remarks) <br /> Purging Equipment: 2" Disposable bailer Y',2) 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" _ 6" L 8" — <br /> Purge Vol. Multiplier: 0.163 0.367 0.653 1.47 2.61 gal/ft. <br /> Initial Measurment Recharae Measurement <br /> Time: `7�U, Time: 106 Calculated purge: <br /> Depth of well: Depth to water: `5 Actual purge: <br /> Depth to water: <br /> eter Calibration Temp. E.C. pH Turbidity <br /> to Initial reading <br /> Time Adjusted reading <br /> Start purge: Sampling time: l I O`� A- Sampling Date: .-GA-ci <br /> Time Temp. E.C. pH Turbidity Volume <br /> °II-S 1 <br /> Sample appearance: <br /> QC samples collected at this well: Lock: ---�-7!Z _ <br /> Equipment replaced: (Check all that apply) Note condition of replaced item. <br /> 2" Locking Cap: Lock #2357: Lock x+0909: � <br /> 4" Locking Cap: Lock #3753: I Lock-Dolphin: <br /> I- <br /> Remarks: <br /> Signature Review <br />