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BLAEfEnvironmental.Management,Ine h GROUNDWATER SAMPLING FORM <br /> PEast Eartt grit e,Suite 478 <br /> PArizona 85012 Well No <br /> I (6nz02)72 7zs-n7n7 N w or) <br /> Well Type E) Monitor El Remedial -VE AS Recovery <br /> Site ID Well Material ❑ PVC ❑ St Steel <br /> Other <br /> Project No Date Time <br /> Recorded By Sampled By <br /> WELL PURGING <br /> IPurge Volume J Purge Date Purge Method <br /> Casing Diameter(D)in inches ❑ Bailer-Type <br /> I ❑ 2-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) Pump Intake Setting <br /> Number of Well Volumes(#Vols)to be Purged <br /> I ❑ 3 ❑ 4 ❑ 5 ❑ Other ❑ Near Bottom ❑ Near Top ❑ Other <br /> Depth to feet(BTOC) <br /> Purge Volume Calulation Screen Interval in Feet(BTOC) from <br /> I 2 to <br /> TD <br /> (feet) WL feet X X X 0 0409 = gallons <br /> ( (feet) D(inches) *Vols Calculated Purge Volume <br /> [Field <br /> ump Time Purge Rate Actual Purge Volume <br /> art Stop Time Elapsed Initial gpm gallons <br /> Parameter Measurements f=inal gpm <br /> Time Time lapsed Gallons Cond I Cond 2 Tem <br /> IPurged (umhoslcm) (umhoslcm) P pH Notes <br /> R <br /> I <br /> Observations During Purging(well Condition,Turbidity,Color Odor,etc <br /> IPurge Water Stora elDis osal <br /> g P ❑ Drum(s), Number E] Storm Sewer ❑ Sanitary Sewer <br /> I Other <br /> WELL SAMPLING <br /> Sampltng Date Sampling Time <br /> ISampling Method I 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 Distnbutton Sample Series <br /> Sample No Containers Vol # Analysis Preservative Lab Comments <br /> Other Notes <br />