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' gL* FJEnvironmentalManagement,Inc GROUNDWATER SAMPLING FORM <br /> 202 East Earll Drive,Suite 478 <br />' Phoenix,Arizona 85012 Well No "(/J_ W"—g A <br /> 602 728 0707 <br /> Well Monito Q Remedial-VE AS Recovery <br /> • Site ID Well E3 PVC El St Steel El Other <br />' Project No �� Date Iz-0-4-'U Time <br /> Recorded By Sampled By <br /> WELL PURGING <br /> Purge Volume Purge Date Purge Method <br /> Casing Diameter(D)in inches ❑ Bailer-Type <br /> ❑ 2-inch 0 4-Inch ❑ 6-inch ❑ Other /' Submersible ❑ Whale <br /> 6j 1 Total Depth of Casing(TD in feet BTOC) _ / P Other <br /> Water Level Depth(WL in feet BTOC) 1(015 Pump Intake Setting <br /> Number of Well Volumes(#Vols)to be Purged <br /> Neat Bottom El Near lop ❑ Other <br /> 3 ❑ 4 ❑ 5 ❑ Other (Depth in feet(BTOC) <br /> Purge Volume Calulahon Screen Interval in Feet(BTOC) from <br /> to <br /> X 3 X 0 0409 = Z�O� g <br /> TD(feet) WL(feet) D(inches) #Vols gallons <br /> Calculated Purge Volume <br /> Pump 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 Cord 2 Tem <br /> Purged (umhos/cm) (umhoslcm) p p� Notes <br /> Observations During Purging(well Condition,Turbidity,Color, Odor,etc <br /> Purge Water Storage/Disposal ] Drum(s), Number [] storm Sewer E] Sanitary Sewer <br /> I Other <br /> WELL SAMPLING <br /> 5ampling Date 17 —001 Sampling Time S� <br /> Sampling 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 /> I <br /> Other Nates <br /> I <br />