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Fi: 9W <br /> SAMPLING INFORMATION SHEET <br /> Client: - Project No: qZ.- 73Y _ <br /> Site: .2y4liff Well Designation: <br /> Lob! <br /> Is setup of traffic control devices required? YES Setup &Takedown time: hours <br /> Is there standing water in well box? Y (Above TOC Below TOC ) <br /> Is Top of Casing cut level? NO &__E ( If NO please explain in remarks) <br /> Is well cap sealed and locked? NO YES ( If NO please explain in remarks) <br /> Height of Wall Casing Riser( in inches) <br /> General condition of Wellhead assembly Excellent Good air Poor (Explain in remarks) <br /> Purging Equipment: 2" Disposable baiter X 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" 8" <br /> Purge Vol. Multiplier: 0.163 0.367 0.653 1.47 2.61 gallft. <br /> Initial.,Mgaurment Recharge Measurement <br /> Time: `7 Time: Calculated purge: Z <br /> Depth of well: Depth to water: Actual purge: <br /> De,, to water: <br /> ter Calibration Temp. E.C. pH Turbidity <br /> e Initial reading <br /> Time Adjusted reading <br /> Start purged ' I G A Sampling time: Sampling Date: -*- <br /> Time Temp. E.C. pH Turbidity Volume <br /> a � <br /> 00,_1 a4z <br /> Sample appearance: ,1 <br /> QC samples collected at this well: Lock: <br /> Equipment replaced: (Check all that apply) Note condition of replaced item. <br /> 2" Lacking Cap: CI Lock #2357: n Lock #0909: --- <br /> 4" Locking Cap: I i Lock #3753: Lock-Dolphin: <br /> Remarks: C-\ <br /> J11J '' V 1 1, <br /> Y.� <br /> "TE-Z= <br /> Signature Review <br />