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BLA -S EnvironmentalManaganent,lna GROUNDWATER SAMPLING FORM <br /> 1433 North Third Avenue <br /> ' Phoenix,Anzona 85007 Weil No <br /> 602 72&0707 <br /> Well Type >rMonitor ❑ Remedial VE AS <br /> Site ID ,,t <br /> ❑ Other <br /> Protect No —� z -76 <br /> �� � Well Material J<PVC D 5t Steel <br /> Recorded By r ❑ Other <br /> ' L -- WELL PURGING <br /> Purge Volume Purge Date If-C, Z- Purge Method <br /> Casing Diameter(D)in inches Bailer Type <br /> 2 inch ❑ 4 inch [] 6 mch ❑ Other ❑ Submersible ❑ Submersible Whale <br /> Total Depth of Casing(TD in feet 7- ❑ Other <br /> Water Level Depth(WL in feet BTOC) t�51-13t Pump Intake Setting <br /> ' Number of Well Volumes(i#Vols) to be ❑ Near Bottom ❑ Near Top ❑ Other <br /> 5e3 ❑ 4 ❑ 5 ❑ Other Depth in feet (BTOC) I - <br /> ' Purge Volume Calulation Screen Interval in Feet(BTOC) Lto <br /> _ 2 to �� <br /> ( f --7? ��-�� X�-- X 3 X 0 0409 = t rf Z- gallons <br /> TD(feet) WL D(inches) ix Vols Calculated Purge Volume <br /> ' Pump Time [Vu-rge—gateAual Purge Volume <br /> Start (q Stop it rE Time Initial gpm gallons <br /> ' Field Parameter Measurements I Final gpm <br /> i —Gallons---Cond 1 Cond 2 WI -t - - - <br /> Time Time Lapsed Purged (umhos/cm) (umhos/cm) Sahrnfy I Temp i Notes <br /> i I <br /> Observations During Purging(well Condition, Turbidity, Color, Odor, <br /> Purge Water Storage/Disposal ❑Drum(s), Number ❑ Storm Sewer ❑Sanitary Sewer <br /> ' Other/Comments o-ii. 9r k 1 1 Otrt 11 a-%- 4A-k <br /> WELL SAMPLING <br /> Sampled By wAo(,- Sampling Date Sampling Time <br /> ' Sampling Method Water Level Before Sampling(in feet BTOC) 156 p <br /> aller Type _ ❑ Same as Above <br /> ' ❑ Submersible ❑ Whale Grab Type <br /> ❑ Other ❑ Other Type <br /> Sampling Distribution Sample Series <br /> ' Sample No Containers, Vol , # Analysis Preservative Lab Comments <br /> to 13 I t <<-kV^ V5b15--"6—',• 2Jo�T _4 <br /> i <br /> Other Notes <br /> 1 i <br />