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BLASS Environmental Management,Inc GROUNDWATER SAMPLING FORM <br /> 1433 North Third Avenue <br /> Phoenix,Arizona 85003 Well No MW-5C <br />`F 602-728-0707 <br /> Well Type ■ Monitor ❑ Remedial -VE AS <br /> WSlte ID U-Haul #709-50 ❑ Other <br /> Project No 002-70950-04 Well Material ■ PVC ❑ St Steel <br /> Recorded By Greg Coffin _ ❑ Other <br /> WELL PURGING <br /> Purge Volume Purge Date Purge Method <br /> Casing Diameter(D)in inches ❑ Bailer-Type <br /> E 2-inch ❑ 4-inch ❑ 6-inch ❑ Other <br /> Submersible ❑ Submersible Whale <br /> Total Depth of Casing(TD in feet BTOC) ❑ Other <br /> Water Level Depth(WL in feet BTOC) Pump Intake Setting <br /> Number of Well Volumes(#Vols)to be Purged <br /> Y-Near Bottom [:1 Near Top El Other <br /> 0 3 ❑ 4 ❑ 5 ❑ Other Depth in feet(BTOC) —1957 <br /> Purge Volume Calulation Screen Interval in Feet(BTOC) from 70 <br /> 2 to 90 <br /> o� � w/teed � X 2 X 3 X 0 0409 = gallons <br /> (feel) ( ) D(inches) #Vols Calculated Purge Volume <br /> Pump Time _ Purge Rate Actual Purge Volume <br /> Start ;t 07 Stop ;1 il Time Elapsed (._,� Initial gpm 13 gallons <br /> Field Parameter Measurements Final gpm <br /> Time Gallons Purged DO% DO(mglL) (uCond rr:) (uCond m) Salinity Temp pH Notes <br /> i1 83 �0 - - <br /> Z s- <br /> i <br /> l - <br /> 2- <br /> Observations During Purging(well Condition,Turbidity, Color Odor,etc <br /> Purge Water Storage/Disposal ❑ Drum(s),Number ❑ Storm Sewer ❑ Sanitary Sewer <br /> Other/Comments Purge water contained in on-site 1 000 gallon poly tank pending analysis/disposal <br /> WELL SAMPLING <br /> Sampled By Sampling Date Y/9- -03 Samplln Time <br /> IIS,aampling Metho / Water Level Before Sampling(in eet BTOC) <br /> I" Bailer-Type ff ❑ Same as Above <br /> ❑ Submersible ❑ Whale ❑ Grab-Type <br /> ❑ Other ❑ Other-Type <br /> Sampling Distribution Sample Series <br /> ISample No Containers,Vol # — Analysis — --Preservative ;� Lab i Comments <br /> _ M Vail, <br /> V_v_A VU.,,i_ 7 ` 2-6e� t•�t t S GK Z r k dx., <br /> 1 7- <br /> Other Notes <br />