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� 9NV=MMWAL SAMPLING INFORMATION SHEET <br /> Client: ±! Project No:— 73!� <br /> Site: 2A14V <br /> M W. &Q7!&—Zff&a Well Designation: m L,_j <br /> 1.ob/ 64 <br /> Is setup of traffic control devices required? YES Setup&Takedown time: hours <br /> Is there standing water in wail box? Y ( Above TOC Below TOC I <br /> Is Top of Casing cut level? NO (YV& If NO please explain in remarks) <br /> Is well cap sealed and lacked? NO E { If NO please explain in remarks) <br /> Haight of Well Casing Riser I in inches) <br /> General condition of Wellhead assembler Excellent l=air Poor {Explain in remarks) <br /> Purging Equipment: 2" Disposable bailer X Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC baiter <br /> Sampled with: Disposal bailer: Teflon Bailer: <br /> Well Diameter: 2" 3" _ 4-X 6" _ g" <br /> Purge Vol. Multiplier: 0.163 0.367 0.653 1.47 2.61 gal/ft. <br /> Time:I 5.1 T1men1T-G, Calculatedur e: <br /> P 9 <br /> Depth of weil: 0 Depth to water: Actual purge: <br /> Depth to water: �1 <br /> F <br /> er Calibration Temp. E.C. pH Turbidity <br /> o Initial reading <br /> e Adjusted reading <br /> Start purge} Sampling time: I OOC) Sampling Date: <br /> Timerr Temp. E.C. pH Turbidity Volume <br /> b 7 '?N'� <br /> b <br /> A- <br /> Sample appearance: <br /> QC samples collected at this well: Lock:J1n <br /> Equipment replaced: (Check all that apply) Note condition of replaced item. <br /> 2" Locking Cap: C Lock ##2357: [] Lock ##0909: r <br /> 4" LockingCap: Lock #3753• i <br /> Lock-Dolphin: 7_7 <br /> Remarks: a , <br /> Signature Review <br />