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' BLAES Envlroomentnl Management,Inc. <br /> GROUNDWATER SAMPLING FORM <br /> 1433 North'Chlyd Avenue <br /> ' Phoenix,Arzzom 85003 Well No 3C w <br /> • 6112 7211,11707 <br /> Well Type (9 Monitor ❑ Remedial VE A5 <br /> Site ID J 4. 5-61 <br /> ❑ Other <br /> ' Project No Som_ -70 '15"0 of <br /> Well Material X PVC ❑ St Steel <br /> Recorded By I - ❑ Other <br /> WELL PURGING ------ -— - T- - - <br /> Purge Volume Purge Date 1 Z- y- a Z_ (Purge Method <br /> Casing Diameter(D)in Inches sailer Type <br /> i ' rX2 Inch ❑ 4 Inch ❑ 5 Inch ❑ Other Submersible ❑ Submersible Whale <br /> Total Depth of Casing(TD in feet gS_17 _ ❑ Other <br /> Water Level Depth(WL In feet BTOC) S"J 7-0 pump Intake Setting <br /> ' Number of Well Volumes(#Vols)to be <br /> �K <br /> 3 [3 4 1-15 ❑ Other Near Bottom [I Near Top ❑ Other <br /> Depth in feet(BTOC) go <br /> ' Purge Volume Calulation Screen Interval In Feet(BTOC) `j <br /> �,' — � 2 X X 110409 to I &X) <br /> TD(feet) <br /> w Z� X ch = � �{ (� gallons D(Inches) #Vols Calculated Purge Volume <br /> Pump Time JPurge Rate Actual Purge Volume <br /> Start 081)Z Stop i7 0 ?-Time IO '" Initial gpm <br /> 2 0 gallons <br /> ' Field Parameter Measurements I Final gpm <br /> Time Time Lapsed Gallons Cond 1 Cond 2 <br /> — - - Purged - (umhos/cm) -(umhos/cm) Salmity Temp -- Notes—� - -- <br /> _ I <br /> I I <br /> ' Observations During Purging(well Condition, Turbidity, Color, Odor <br /> Purge Water Storage/Disposal ❑Drum(s), Number <br /> ❑ Storm Sewer C1 Sanitary Sewer <br /> ' Other/Comments 10y A 4 <br /> WELL SAMPLING <br /> Sampled By: iu?& _ Sampling Date ISampling Time, <br /> ' Sampling Method I « Water Level Before Sampling(In feet BTOC) <br /> [Bailer Type 7 ❑ Same as Above <br /> ' ❑ Submersible ❑ Whale `Grab Type <br /> ❑ Other ❑ Other Type <br /> Sampling Distribution Sample Series <br /> ' Sample No Containers,Vol ,# Analysts Preservative Lab Comments <br /> �i LVbgI �( & etct L� <br /> I <br /> I <br /> ' Other Notes I <br /> i <br />