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' BLAE$Environmental h12n2gement,Inc, GR0UNDYy <br /> ATER SAMPLING FORM <br /> 1433 North Third Avenue <br /> ' Phoeaix,Anzana 85003 Well No.. _ ^ <br /> baa 72a-0707 <br /> • Well Type )Ef-Monitor ❑ Remedial VE AS <br /> Site ID ,�� <br /> ❑ Other <br /> ' Project No d C L - -7 0q t�-b - G Well Material %PVC ❑ St Steel <br /> Recorded By <br /> ❑ Other <br /> WELL PURGING - - --- - -- - - - <br /> Purge Volume Purge Date Purge Method <br /> Casing Diameter(D)in Inches ❑ Boller Type <br /> ' D<2 Inch ❑ 41nch ❑ 5 Inch ❑ Other Submersible ❑ Submersible Whale <br /> Total Depth of Casing(TD in feet ❑ Other <br /> Water Level Depth(WL In feet BTOC) Pump lntake Setting I <br /> t Number of Well Volumes(#Vols)to be <br /> [9 3 El 4 C3 5 1:1 Other Near Bottom ❑ Near Top Other <br /> Depth In feet(BTOC) 5 <br /> ' Purge Volume Calulation Screen Interval in Feet(BTOC) /J <br /> 27, to _ 70 <br /> TD(reetlr v , X X 3X 00409 = gallons <br /> D(Inches) #Vols Calculated Purge Volume <br /> ' Pump time Purge Rate JACtual Purge Volume <br /> Start l 110 Stop Time Initial�j �1 gpm 7_ gallons <br /> Field Parameter Measurements j Final ^l gpm <br /> Gallons Cond 1 Cond 2 1 - <br /> Time Time Lapsed Salinity I Temp Notes <br /> Purged (urnhos/cm) -(umhos/cm) W — - , ��— - -- <br /> s <br /> I <br /> Observations During Purging(well Condition, Turbidity, Color, Odor, y t -#it l�jd 5 f vd,t <br /> aJ—Of <br /> Purge Water Storage/Disposal ❑Drum(s), Number ❑ storm Sewer ❑ Sanitary Sewer <br /> ' Other/Comments o ak:, a((o ti ie, <br /> WELL SAMPLING —� <br /> Sampled By w0C,- JSampling Date I [SamplingTlme <br /> ' Sampling Method Water Level Before Sampling(In feet STOC) �S c <br /> [&Bailer Type �� ❑ Same as Above H'a <br /> ❑ Submersible ❑ Whale &Grab Type ` <br /> ❑ Other ❑ Other Type <br /> Sampling Distribution Sample Serres <br /> ' Sample No Containers, Vol ,# Analysis Preservative I Lab Comments I <br /> Z uo4 i of 6• H C <br /> Other Notes <br /> 1 <br />