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gLA* UEnvironmentalManagement,Inc GROUNDWATER SAMPLING FORM <br /> 202 East Earil Drive,Suite478 r. <br /> Phoenix,Arizona 85012 Well No PW V,) <br /> I 642 728 0707 <br /> Well ❑ Monito ❑ Remedial-VE AS Recovery <br /> Site ID <br /> Wel! ❑ PVC C1St Steel 13Other <br /> I <br /> Project No Date_ 1z�G,.c�D Time <br /> Recorded By Sampled By <br /> WELL PURGING <br /> Purge VOlume Purge Date Purge Method <br /> Casing Diameter(D)m inches ❑ Bader-Type <br /> q12-inch ❑ 4-inch ❑ 6-inch ❑ Other Submersible ❑ Whale <br /> Total Depth of Casing(TD in feet BTOC) ( Other <br /> Water Level Depth(WL in feet BTOC) 0412a„ __ pump Intake Setting <br /> Number of Well Volumes(#Vols)to be Purged <br /> Near Bottom [3 Near Top El Other <br /> A 3 ❑ 4 ❑ 5 ❑ Other Depth in feet(BTOC) <br /> IPurge Volume Calulation Screen Interval in Feet(BTOC) from <br /> I 7 f ---L'-Zq X �— z X 3 X 0 0409 = to <br /> TD(feet) WL(feet) D(inches) #Vols gallons <br /> Calculated Purge Volume <br /> Pump Time Purge RateActual Purge Volume <br /> Start �N" Stop 10 Time Elapsed Initial gpm gallons <br /> Field Parameter Measurements Final gpm <br /> Time Time Lapsed Gallons Cond t Cond 2 <br /> Temp PB Notesr ed (umhos/cm) (umhaslcm) <br /> Observations During Purging(well Condition,Turbidity,Color, Odor,etc <br /> Purge Water Storage/Disposal ❑ Drum(s),Number ❑ Storm Sewer ❑ Sanitary Sewer <br /> Other <br /> WELL SAMPLING <br /> Sampling Date- �^ Sampling Time i 666 <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 />