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1 <br /> BLAES EnviroumentaiManagement,Inc GROUNDWATER SAMPLING FORM <br /> ' 1433 North Third Avenge MW-11 B <br /> 4 <br /> Phoenix,Arizoaa 85003 Well NO <br /> oz-yas-o7a7 <br /> Well Type ■ Monitor ❑ Remedial-VE AS <br /> ' Site ID U-Haul #709-50 0 Other <br /> Project No 002-70950-06 Well Material ■ PVC ❑ St Steel <br /> Recorded By ':�✓ ❑ Other <br /> ' WELL PURGING <br /> Purge Volume IPurge Date JPurge Method <br /> Casing Diameter(D)in inches _ ;ig Bailer-Type > <br /> E 2-inch ❑ 4-inch ❑ 6-inch ❑ Other _&-&�ble ❑ Submersible Whale <br /> Total Depth of Casing(TD in feet BTOC) 60 ❑ Other <br /> ' Water level Depth(WL in feet BTOC) SZb r <br /> Pump Intake Setting <br /> Number of Well Volumes(#Vols)to be Purged <br /> E Near Bottom El Near Top El Other <br /> 0 3 ❑ 4 [:15 ❑ Other Depth in feet(BTOC) ~55 <br /> Purge Volume Calulation Screen Interval in Feet(BTOC) from 40 <br /> to 60 <br /> 60 �� i 2 z X —3 X 0 0409 = `�� gallons <br /> ' TD(feet) WL(feet) X D(inches) #Vols Calculated Purge Volume <br /> Pump Time Purge Rate Actual Purge Voiume <br /> Start `Pty Stop Time Elapsed Initial gpm ( gallons <br /> Field Parameter Measurements Final gpm <br /> ' <br /> Time Gallons Purged! D09'o DO(mglL) Cond 1 Cond 2Sa[iniiy I Temp Notes <br /> (umhoslcm) (umhoslcm) <br /> 13 Z� - �z <br /> ' Observations During Purging(well Condition,Turbidity,Color,Odor,etc A5 ;S r'L- <br /> ' Purge Water Storage/Disposal ❑ Drum(s),Number ❑ Storm Sewer ❑ Sanitary Sewer <br /> Other/Comments <br /> WELL SAMPLING <br /> ' Sampled By: grC� SL,/ _ Sampling Date Ss( 1D pf ISampling Time 1 $.5-/ <br /> Sampling Method Water Level Before Sampling(in feet BTOC) N <br /> ' E Bailer-Type 3' Disposable ❑ Same as Above <br /> ❑ Submersible ❑ Whale ❑ Grab-Type <br /> ❑ Other ❑ Other-Type <br /> ' Sampling glstribution Sample Series <br /> Sample No I Containers,Vol,#—� Analysis I Preservative i Lab „� _ Comments <br /> ^ (1) 1 L Amber 8015 Diesel <br /> MW-11 B (2)40mL Amber Voa's HCI ESC I r <br /> Gasoline — <br /> ' 2 40mL Amber Voa's 8260 BTEX, Fuel Oxy's, 1,1- <br /> O I DCA, 1,2-DCA <br /> ' Other Notes ✓+S.44c i e fir' S i:- I L,k�' � <br />