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' BLAES Environmental Management, GROUNDWATER SAMPLING FORM <br /> 1433 North Third Avenue <br /> I Phoenix,Arizona 85003 Well No MW-913 <br /> 602-72$-0707 <br /> Well Type ■ Monitor ❑ Remedial -VE AS <br /> Site ID U-Haul #709-50 ❑ Other <br /> Project No 002-70950-04 <br /> Well Material ■ PVC ❑ St Steel <br /> Recorded By Greq_Coffin ❑ Other <br /> WELL PURGING <br /> Purge Volume Purge Date Q o, 3 JPurge Method <br /> Casing Diameter(D)in inches ❑ Bailer-Type <br /> I E 2-inch ❑ 4-inch ❑ 6-inch ❑ Other © 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 /> 3 ❑ 4 ❑ 5 ❑ Other ❑ Near Bottom ❑ Near Top ❑ Other <br /> Depth in feet(BTOC) <br /> Purge Volume Calulation Screen Interval in Feet(BTOC) from 52 <br /> z to 77 <br /> T <br /> -7-Z eU ee ) X 2 X 3 X 0 0409 = S ;-7 gallons <br /> TD(Feet)et) WL(feet)) D(inches) #Vols g <br /> Calculated Purge Volume <br /> Pump Time Purge Rate Actual Purge Volume <br /> Start 13f I- Stop Time Elapsed Initial gpm gallons <br /> Field Parameter Measurements Final gpm <br /> Time Gallons Purged DO% DO(mg/L) Cond 9 Cond 2 Salinity Temp pH Notes <br /> (umhoslcm) (umhoslcm) <br /> I <br /> Observations During Purging(well Condition Turbidity Color,Odor,etc <br /> Purge Water Storage/Disposal ❑ Drum(s), Number ❑ Storm Sewer ❑ Sanitary Sewer <br /> Other I Comments Purge water contained in on-site 1 000 gallon poly tank pending analysis/disposal <br /> WELL SAMPLING <br /> Sampled �l/ Sampling Date f <br /> By //U/075 Sampling Tlme <br /> Sampling Method t— Water Level Before Sampling(in feet BTOC) <br /> aBaller-Type �` ;S�a�.=, +— __, ❑ Same as Above <br /> ❑ Submersible ❑ Whale ❑ Grab-Type <br /> ❑ Other ❑ Other-Type <br /> Sampling Distribut[on Sample Series <br /> Sample No _ - Containers, Vol # w Analysis Preservative �— Lab _ Comments <br /> ----- -- - vn _t117._I. A 3 <br /> Other Notes <br /> I <br />