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tBRAE EnvIronmentalmanagement,inc GROUNDWATER SAMPLING FORM <br /> 202 East Earil Drive,Suite 478 T <br />' Phocncx,AriZanq 85012 Well NO {�}3 <br /> 602 728 0707 <br /> Well � Monito ❑ Remedial-VE AS Recovery <br /> Site ID Well 12 PVC El St Steel El Other <br />' Protect No 5Tbc.KTa rJ Date l2 5 0_0 Time <br /> Recorded By 4 C- Sampled By 4 L <br />' WELL PURGING <br /> Purge Volume JPurge Date Purge Method <br /> Casing Diameter(D)in Inches ❑ Bailer-Type <br /> ❑ 2-inch 5Q 4-inch ❑ 6-inch ❑ Other Submersible ❑ Whale <br /> Total Depth of Casing(TD in feet BTOC) Q ❑ Other <br /> Water Level Depth(WL in feet BTOC) Pump Intake Setting <br /> Number of Well Volumes(#Vols)to be Purged <br /> 3 ❑ 4 ❑ 5 ❑ Other Near Bottom ❑ Near Top ❑ Other 70 <br /> Depth in feet(BTOC) x -7-1 <br /> Purge Volume Calulation Screen Interval in Feet(BTOC) from <br /> R _�' — �7 __7f X q 2 X 3 to <br /> X 0 04Q9 <br /> TD(feet) WL(feet) D(inches) #Vols gallons <br /> Calculated Purge Volume <br /> Pump Time JPurge Rate Actual Purge Volume <br /> Start �2•oy Stop I� Time Elapsed 30h.i Initial Y7gpne3coOt U gallons <br />' Field Parameter Measurements Final •5 ppm <br /> Time Time Lapsed Gallons Cond 1 Cond 2 <br /> p Purged (umhoslcm) (umhos/cm) Temp pH Notes <br /> Observations During Purging(well Condition, Turbidity,Color, Odor,etc <br /> Purge Water Storage/DisposalDrum(s) Number E] Storm Sewer ❑ Sanitary Sewer <br /> I ther <br /> WELL SAMPLING <br /> Sampling Date I kZ-{ -C O. Sampling Time <br /> I Sampling Method Water Level Before Sampling (in feet BTOC) <br /> f Bailer-Type ❑ Same as Above <br /> LJ Submersible ❑ Whale ❑ Grab-Type <br /> ❑ Other ❑ Other-Type <br /> Sampling Distribution Sample Series <br /> Sample No <br /> Containers,Vol # Analysis Preservative Lab Comments <br /> Other Notes <br /> I <br />