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W — <br /> BLAES Cmironmental Management,Inc GROUNDWATER SAMPLING FORM - <br /> -- <br /> 1433 North Third Avenue —� <br /> Phoenix,Arizona 85003 Well No.: <br /> • <br /> Site <br /> e ID 728-0707 Well Type El Monitor El Remedial -VE AS Slt <br /> ❑ Other <br /> Prorect No Well Material Cl PVC 1] St Steel <br /> Recorded By Cl Other <br /> L WELL PURGING <br /> Purge Volume Purge Date: I Purge Method <br /> Casing Diameter(D) In Inches ❑ Bailer-Type <br /> ❑ 2-Inch ❑ +Inch ❑ 6-Inch ❑ Other ❑ 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 ❑ Near Bottom ❑ Near Top ❑ Other <br /> ❑ 3 ❑ 4 ❑ 5 ❑ Other Depth In feet (BTOC) <br /> Purge Volume Calulation Screen Interval In Feet (BTOC) from <br /> y to <br /> WL(feet) X X X 00409 gallons <br /> TD(feet) i D(Inches) #Vols Calculated Purge Volume <br /> Pump TimePurge Rate Actual Purge Volume <br /> Start Stoo Time Elapsed Initial grim gallons <br /> Field Parameter Measurements Final eom <br /> Time Time Lapsed Gallons Cond i Cond 2 I Temp pH — Notes <br /> Purged (umhoslcm) (umhos/cm) <br /> Observations During Purging(well Condition, Turbidity, Color, Odor,etc I <br /> Purge Water Storage/Disposal ❑ Drum(s),Number ❑ Storm Sewer ❑ Sanitary Sewer <br /> Other <br /> WELL SAMPLING _ <br /> Sampled By: Sampling Date: Sampling Time: <br /> Sampling Method —� Water Level Before Sampling(in feet BTOC) <br /> ❑ Bailer-Type ❑ Same as Above <br /> ❑ Submersible ❑ Whale ❑ Grab-Type <br /> ❑ Other ❑ Other-Type <br /> Sampling Distribution Sample Series <br /> Sample No Containers,Vol ,# Analysis Preservatroe = Lary Comments <br /> i <br /> Other Notes <br />