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BLAUEnvironmentalManngement,Inc GROUNDWATER SAMPLING FORM <br /> 202 East Earl]Xlrive,Suite 478 <br /> I Phoenix,Arizona 85012 Well No (� <br /> 602 728-0'!07 <br /> Well © Monito C7 Remedial-VE AS Recovery <br /> • Site ID Well ❑ PVC ❑ St Steel ❑ Other <br /> f Project Na Date Trme <br /> f Recorded By _ Sampled By <br /> WELL PURGING <br /> Purge Volume Purge Date Purge Method <br /> Casing Diameter(D)in inches ❑ Bailer-Type <br /> 12-inch ❑ 4-inch ❑ 6-tnch ❑ Other � Submersible ❑ Whale <br /> Total Depth of Casing(TD in feet BTOC) ,SS u Other <br /> Water Level Depth(WL in feet BTOC) _ s Pump Intake Setting <br /> Number of Well Volumes(#Vols)to be Purged <br /> Ea 3 ❑ 4 ❑ 5 ❑ Other 4Nj Near Bottom ❑ Near Top ❑ Other <br /> Depth in feet(BTOC) <br /> Purge Volume Calulation Screen Interval in Feet(BTOC) from <br /> r ll 2 to <br /> Xy X 3 X 0 0409 2-0 ° 1 gallons <br /> L TD(feet) WL(feet) J D(inches) #Vols Calculated Purge Volume+ <br /> Pump Time Purge Rate Actual Purge Volume <br /> Start'2-""7 Stop 3'zs Time Elapsed Initial o s qpm @31}OF Z 2 s gallons <br /> �2ao <br /> Field Parameter Measurements Final qpm <br /> Time Time Lapsed Gallons Cond 1 Cond 2 Tem <br /> Purged (umhos/cm) (umhoslcm) p pH Notes <br /> Observations During Purging(well Condition,Turbidity,Color, Odor,etc <br /> Purge Water Storage/Disposal )n Drum(s),Number ❑ Storm Sewer ❑ Sanitary Sewer <br /> Other <br /> WELL SAMPLING <br /> Sampling Date 1 1-7-4o-0 Z) Sampling Ttme 11 '30/11" <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 /> V&A-S <br /> Other Notes <br />