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MONITORING-WELD SAMPLING INFORMATION SHEET_ <br /> Mom-- _ z Project No: <br /> Site: -Mp p! Well Designation: <br /> �12h71rJ- 3 <br /> .3iry- sn G4 . ,. . <br /> Is setup of tMMit control devices mquiredl PF9TYES Setup do Takedown time: houm <br /> is ihar*etanditrgmom in well box? 5bYES (Above TOC Relou TOC) <br /> Is Top of Casing cut levels NG (If NO please expinin in ranuuits) <br /> !s wed cap aseled and lociced? NO (ff NO please explain In ranggg cs) <br /> He"ght of Weil Clang Riser 0n inches) 2 <br /> Ciarreral condition of werdhead asambly Excellent �G Fair Poor (Ezplan in nanarks) <br /> Purging Equipfinertt: 2' Disposable—bailer Submersible pump <br /> 2" PVC baiter Dedicated bailer <br /> 4" PVC bailer <br /> Sampled Disposal bailer: Teflon Bailer: <br /> Well Diameter: 21' 3" 4" 6" 8" <br /> Purge Vol. MuMpOer. 0.163 0.367 0.653 1.47 2.61 gaunt. <br /> Time: 1 Za Time: Calculated purge: 6 <br /> Depth of well: Depth to water: Actual purge: <br /> to water: <br /> Start purge: 7 y qq Sampling time: w -5-4 Sampling Date: <br /> Time Temp ( F) I E.C. pH Turbidity O (ppm) Volume (Gal.) <br /> SM <br /> Sample appearance: <br /> OC=mpiss coilected at this well: Lock: <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 />