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BLAS SEuvironment2iManagement,fnc. GROUNDWATER SAMPLING FORM <br /> 1433 North Third Avenue - <br /> Phaeaix,Arizona 151103 Wel! No . C1 <br /> 111 7211-0707 <br /> Well Type &Monitor ❑ Remedial VE AS <br /> Site ID [,l - w <br /> _ El Other <br /> ' Project Ifo &t& L- 0`t'S 0 — 03 Well Material PVC ❑ St Steel <br /> Recorded By ❑ Other <br /> - WELL PURGING --- ----_ _ --« --- -u <br /> Purge Volume Purge Date !Z if_ p Z Purge Method <br /> Casing Diameter(D)in inches ❑ Bailer Type <br /> ;&2 inch [] 4 inch ❑ 6 inch ❑ Other <br /> Submersible E] Submersible Whale <br /> Total Depth of Casing(TD in feet E7-21 ❑ Other <br /> Water Level Depth(WL to feet BTOC) 57 77, pump Intake Setting J <br /> Number of Well Volumes(# Vols)to be `Near Bottom ❑ Near Top ❑ Other <br /> P<3 ❑ 4 ❑ 5 ❑ Other Depth to feet(BTOC) SO <br /> ' Purge Volume Calulation Screen Interval in Feet(STOC) --70 <br /> 2 to <br /> 6 7 1 L 7 7L X�s) X X 00409 = 1`� gallons <br /> TD fleet} W! D(inches) #Vo1s Calculated Purge Volume <br /> ' Pump Time Purge Rate JActual Purge Volume <br /> Start G' Stop_151t" Time rQ Initial t gpm �C,r gallons <br /> ' Field Parameter Measurements Final —gpm_f <br /> Time Time Lapsed Gallons— Cond ] Card 2 <br /> -- - - - --- I' I -- <br /> _----- - v Purged (umhos/Cm) {umhos/cmSalm ty Temp Notes <br /> ) <br /> I , <br /> i <br /> 1 <br /> Observations During Purging(well Condition, Turbidity, Color, Odor, ✓ w,) <br /> Purge Water Storage/Disposal ❑Drum(s), Number <br /> ❑ Storm Sewer [I sanitary Sewer <br /> ' Other/Comments 3 L a►b 4(tom —}esu <br /> WELL SAMPLING <br /> Sampled By. V40Cr Isampling Date IrL--s—o z_ Sampling Time <br /> ' Sampling Method I Water Level Before Sampling(in feet BTOC) 7, <br /> � ,� <br /> Bader Type if El Same as Above <br /> 1 ❑ Submersible ❑ Whale firGrab Type <br /> ❑ Other ❑ Other Type i <br /> E <br /> Sampling Distribution Sample Series <br /> Sample No — Containers, Vol ,# AnalystsPreservative Lab Comments <br /> 1►1-V — L ✓ ( t twt <br /> v o c 5 <br /> Other Notes <br /> i <br /> l <br />