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B,LAES X-nAroamentalNWnagemeat,Ine. GROUNDWATER SAMPLING FORM <br /> 1433 North Third Aveaue - -• -- --- <br /> ' Phoeniz,Arizona 85003 Well No <br /> 111718-1717 <br /> Well Type WMonitor C3 Remedial VE AS <br /> Site ID 01- 5 ��� ❑ Other <br /> ' Protect No &n Z.- 7n Well Material �BCPVC ❑ St Steel <br /> Recorded By _ _ _ _ ❑ Other <br /> WELL PURGING <br /> Purge Volume Purge Date If - t:Z Purge Method <br /> Casing Diameter(D) in inches ❑ Baiier Type <br /> ' 02 inch [] 4 inch ❑ 6 inch ❑ Other Submersible ❑ Submersible Whale <br /> Total Depth of Casing(TO in feet C4R'.'fb ❑ Other <br /> Water Level Depth(WL in feet BTOC) _ j 7. T2- Pump Intake Setting <br /> 1 Number of Well Volumes(#Vols)to be <br /> 9 Near Bottom ❑ Near Top ❑ Other <br /> 93 ❑ 4 [:15 ❑ Other Depth in feet(BTOC) 90 <br /> 1 Purge Volume Calvlation Screen Interval in Feet(BTOC) <br /> 2 to /oo <br /> 5 X X X 0 0409 = D- gallons <br /> TD(feet) WL J D(inches) #Vots Calculated Purge Volume <br /> ' Pump Time Purge Rate Actual Purge Volume <br /> Start !GI-pt Stop I G O Time —S Initial L gpm Lgallons <br /> ' Field Parameter Measurements j Final gpm <br /> Gallons Cond I Cond 2 I a <br /> • --Time - Time Lapsed Purged (umhos/cm) { mho u _--s/cm) 5alrmty Temp - Notes-- - <br /> mho <br /> I <br /> I <br /> Observations During Purging(well Condition, Turbidity, Color, Odor, <br /> 7 1�L -tilt V'. <br /> Purge Water Storage/Disposal ❑Drum(s), Number ❑ Storm Sewer ❑ Sanitary Sewer <br /> ' Other /Comments 4'1f+-1-r <br /> WELL SAMPLING <br /> Sampled By- PG- Sampling Date t2-5- OZ Sa_mplingTime <br /> ' Sampling Method I Water Level Before Sampling(in feet BTOC) <br /> Bailer Type 2- f y ❑ Same as Above <br /> 1 ❑ Submersible ❑ Whale Grab Type <br /> ❑ Other ❑ Other Type <br /> Sampling Distribution Sample Series <br /> ' Sample No Containers, Vol , # Analysis Preservative Lab Comments <br /> IMS' JAr ?Dt -D r M...✓ <br /> Other Notes <br />