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SAMPLING INFORMATION SHEET � <br /> Client: <br /> Al Project No: �z- 7m3 <br /> Site: 22M �. ,(( <br /> LD�J AV We Designation:_yN <br /> Is setup of traffic cormoi devices required? YES Setup &Takedown time: hours <br /> Is there standing water in well box? Y S (Above TOC Below TOC ) <br /> Is Top of Casing cut level? : NO ( If No Pismo explain in remarks! <br /> Is well cap sealed and locked? : NO ( If NO please explain in remarks! <br /> Height of Wall Casing Riser ( In inches) <br /> General condition of Wellhead assembly Excellent o hair 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: Teflon Bailer: 0 <br /> Well Diameter: 2" _ 3" 4" s„ 8" <br /> Purge Vol. Multiplier: 0.163 0.367 0.653 1.47 2.61 gai/ft. <br /> --Initial Measurment —Rscharas Measurement <br /> Time: Time: L,/"' Calculated purge: <br /> Depth of well: Depth to water: Actual purge: <br /> Depth to water: <br /> F <br /> er Calibration Temp. E.C. pH Turbidity <br /> o Initial reading <br /> e Adjusted reading <br /> Start purge:OQp Sampling time: Sampling Date: g_,�') <br /> Time Temp. E.C. pH Turbidity Volume <br /> 7 <br /> ti <br /> Sample appearance: CS n <br /> QC samples collected at this well: �� Lock: Q �� <br /> Equipment re laced: <br /> P (Check all that apply) Note condition of replaced item. <br /> 2" Locking Cap: Lock #2357: = Lock #0909: <br /> 4" LockingCap:p• Lock #3753: h Lock-Dolphin: <br /> Remarks: UJej'-� <br /> Signature Review <br />