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BLL. Ef Environmental Management,Inc GROUNDWATER ROUNDWATER SAMPLING FORM <br /> 202 East Earll Drive,Suite 478 f <br /> Phoenix,Arizona 85012 Well NO _-7, +� <br /> 602 728 0707 <br /> Well E3 Monito © Remedial-VE AS Recovery <br /> Site ID _ Well © PVC © St Steel 11 Other <br /> Protect No �� Date Time <br /> I Recorded By Sampled B <br /> P Y <br /> WELL PURGING <br /> Purge Volume Purge Date----[_ Purge Method <br /> Casing Diameter(D)in inches ❑ Sailer-Type <br /> I ® 2-inch ❑ 4-inch ❑ 6-inch ❑ Other ;Q Submersible ❑ Whale <br /> Total Depth of Casing(TD in feet BTOC) S. L ❑ Other <br /> Water Level Depth(WL in feet STOC) IPump Intake Setting <br /> Number of Well Volumes(#Vols)to be Purged <br /> Near Bottom El Near Top ❑ Other <br /> 3 El 4 [:] 5 [1 Other Depth in feet(BTOC) <br /> Purge Volume Calulation Screen Interval in Feet(BTOC) from <br /> 2 X � X Q 04Q9 = �� to <br /> gallons <br /> D <br /> TD(feet) WL(feet) (inches) #Vols Calculated Purge Volume g <br /> Pump Time Purge Rate Actual Purge Volume <br /> Start Stop Time Elapsed Initial qpm gallons <br /> Field Parameter Measurements Final qpm <br /> Time Time Lapsed Gallons Cond 1 Cond 2 <br /> p Temp pH [Votes <br /> Purged (umhoslcm <br /> (umhoslcm) <br /> Observations During Purging(well Condition,Turbidity,Color, Odor,etc <br /> Purge Water Storage/Disposal Drum(s),Number ❑ Storm Sewer ❑ SanitarySewer <br /> Other <br /> WELL SAMPLING <br /> Sampling Date I 12-7 —0o 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 Preservative Lab Comments <br /> Other Notes <br />