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IBLAU Environmental Management,Inc GROUNDWATER SAMPLING FORM <br /> 202 East Earll Drive,Suite 478 <br /> Phoenix,Arizona 85012 Well No �/1J �edjaj -"VE )A <br /> 602 728 0707 <br /> WellType ❑ Monitor " Recovery <br /> Site ]D Well Material ❑ PVC <br /> St Steel 0 OtherProtect No C /' Date Time <br /> Recorded By J Sampled By <br /> WELL PURGING <br />' Purge Volume IPurge Method <br /> Casing Diameter(D)in inches ❑ Bailer-Type <br /> ❑ 2-inch ff4 4-inch ❑ 6-inch ❑ Other ❑ Submersible ❑ Whale <br /> Totai Depth of Casing(TD in feet BTOC) _ �{j UJ ❑ Other <br /> Water Level Depth(WL in feet STOC) �{s •S Z <br /> Number of Well Volumes(#Vols)to be Purged Pump Intake Setting <br /> [R3 ❑ 4 ❑ 5 ❑ Other ElNear Bottom ElNear Top ElOther <br /> Depth in feet(BTOC) <br /> Purge Volume Calulation Screen Interval in Feet(BTOC) from <br /> _ 2 to <br /> TD feet X X X 0 0409 = gallons <br /> (—feet)— WL(feet) D(inches) #Vols Calculated Purge Volume <br /> IPump Time Purge Rate Actual Purge Volume <br /> Start Stop Time Elapsed Initial gpm gallons <br /> Field Parameter Measurements Final gpm <br /> Time Time Lapsed Gallons Cond 1 Cond 2 <br /> Purged (umhoslcm) (umhoslcm) Temp ply Notes <br /> I <br /> I <br /> Observations During Purging(well Condition Turbidity, Color, Odor,etc <br /> IPurge Water Storage/Disposals <br /> ❑ Drum(s), Number E] Storm Sewer ❑ Sanitary Sewer <br /> Other <br /> WELL SAMPLING <br /> Sampling Date 17--:1 —oto 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 Container Vol ,# Analysis Preservative Lab Comments <br /> zz � <br /> R <br /> Daher Notes <br />