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till <br />' BLAEl Environmental Management,Inc GROUNDWATER SAMPLING FORM <br /> 202 East Earl!Drive,Suite 178 � , , ^ <br /> Phoenix,Ari ►AJzona 85012 Well No —,(.O <br />' 602 72$-0707 <br /> Well ❑ Monito [:] Remedial-VE AS Recovery <br /> Site ID <br /> Project No C' Well <br /> tle � C 11 St Steel 12 Other <br /> Time <br /> Recorded By Sampled By <br /> I WELL PURGING <br /> Purge Volume Purge Date__J__ Purge Method <br /> Casing Diameter(D)in inches ❑ Bailer-Type <br /> I 2-Inch ❑ 4-inch ❑ 6-inch ❑ Other Submersible ❑ Whale <br /> otal Depth of Casing(TD in feet BTOC) _ �` _ 9Other <br /> Water Level Depth(WL in feet BTOC) 2 <br /> Pump Intake Setting <br /> I Number of Well Volumes(#Vols)to be Purged <br /> [� 3 ❑ 4 ❑ 5 ❑ Other yp Near Bottom ❑ Near Top El Other <br /> epth in feet(BTOC) <br /> Purge Volume Calulation Screen Interval in Feet(BTOC) from <br />' _ 4 2 to <br /> � -`D— �'q Z X X X 0 0409 = �� gallons <br /> (feet) WL(feet) D(inches) #Vols Calculated Purge Volume <br /> Pump Time Purge Rate Actual Purge Volume <br /> Start(19-SS Stap Time Elapsed { t Initial gpm gallons <br /> Field Parameter Measurements Final qpm <br /> Time Time Lapsed Gallons Cond 1 Cond 2 <br /> Purged (umhoslcm) (umhoslcm) Temp pH Notes <br /> Observations During Purging{well Condition,Turbidity,Color, Odor,etc <br /> Purge Water Storage/Disposal %AM, Drum(s), Number ❑ Storm Sewer ❑ Sanitary Sewer <br /> I Other <br /> WELL SAMPLING <br /> Sampling Date i1–b-0 ISampling Time 3 'S <br /> ISampling Method Water Level Before Sampling(in feet BTOC) <br /> Bailer-Type ❑ Same as Above <br /> ❑ Submersible ❑ Whale ❑ Grab-Type <br /> ❑ Other <br /> ❑ Other-Type <br /> Sampling Distribution Sample Series <br /> Sample No Containers,Vol ,# Analysis Preservative Lab Comments <br /> Other Notes <br /> I <br />