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MONITORING WELL SAMPLING INFORMATION SHEET <br /> Cirent: � ; z Project No: <br /> Site: 2455 t f Well Designation: ~ <br /> Is setup of traffic control devices required' YES Setup &Takedown time hours <br /> Is there standing weter In well box* YES (Above TOC Below TOC ) <br /> Is Top of Casing cut lever Nv ES- (If NO please expiain in remarks) <br /> Is well cap sealed and locked) NO, 113� (If NO please explain in remarks) <br /> Height of Well Casing Riser(in inches) _ _ `i <br /> General condition of Wellhead assembly Excellentoo Farr Poor (Explain 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" A 3" 4" 611 811 <br /> Purge Vol. Multiplier- 0.163 0.367 0.653 1.47 261 gavft <br /> al rit �chgme Measurement <br /> r <br /> : Time: Calculated purge:of well: ; �� Depth to water: Actual purge:#o water: y �z <br /> Start purge: 9 r 3Z Sampling time: l D'•`•I 3 Sampling Date: <br /> Time Temp ( F) I E.C. pH Turbidity O (ppm) Volume (Gal.) <br /> S , �4a Gl 1. 3f f0 3 <br /> LID <br /> Z <br /> Sample appearance: <br /> OC samples collected at this well. rloy%-e- Lock: I00 6y <br /> Equipment replaced: (Check all that apply) Note condition of replaced item. <br /> 2" Locking Cap: Lock#2357: Lock #0909: <br /> 3" Locking Cap: Lock #3753: Lock-Dolphin: <br /> 4" Locking Cap: Chevron Lock: <br /> Remarks: <br /> Signature Review <br />