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CIi�14 aft. SAMPLING INFORMATION SHEET <br /> Client: -#' Project No: C7Z- 7 <br /> Site: Well Designation: Y n <br /> LoD1 <br /> Is setup of traffic control devices required? YES Setup &Takedown time: hours <br /> Is there standing water In wail box? . YES (Above TOC Below TOC ) <br /> Is Top of Casing cut level? . YES ( If NO please explain in remarks) <br /> Is well cap sealed and locked? : 0 YES (If NO please explain in remarks) <br /> Height of Well Casing Riser( in inches) <br /> General condition of Wellhead assembly Excellent Good Fair Poor Expiain 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"-,)<' 6" g" <br /> Purge Vol. Multiplier: 0.163 0.367 0.653 1.47 2.61 gal/ft. <br /> Initial Measurment Recharae Measurement <br /> Time:700',k Time: Calculated purge: <br /> Depth of _61well: � Depth to water: Actual purge: <br /> Depth to water: <br /> ater Calibration Temp. E.C. pH Turbidity <br /> to Initial reading <br /> Time Adjusted reading <br /> Start purge: Sampling time: �221 <br /> Rg Date: �--- <br /> . <br /> Time Temp. E.C. pH Turbidity Volume " <br /> I <br /> Sample appearance: <br /> CLC samples collected at this well: Lock: 2] 5 D— <br /> Equipment replaced: (Check all that apply) Note condition of replaced item. <br /> 2" Locking Cap: U Lock #2357: 0 Lock #0909: <br /> 4" Locking Cap: Lock #3753 F-7 Lock-Dolphin: <br /> Remarks: ' �P t <br /> n ht 1 rt ✓t�` <br /> Signature Review <br />