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BLAES EnvironmentalManagement,lnc GROUNDWATER SAMPLING FORM <br /> 1433 North Third Avenue <br /> Phoenix,Arizona 85003 Well No MW-113 <br /> 602-728-0707 <br /> Well Type ■ Monitor ❑ Remedial-VE AS <br /> Site ID __U!-Haul #709-50 © Other <br /> Project No 002-70950-04 Well Material ■ PVC ❑ St Steel <br /> Recorded By Gree Coffin ❑ Other <br /> WELL PURGING <br /> Purge Volume Purge Date - Purge Method ` <br /> Casing Diameter(D)in inches Bailer-Type ` / CJ <br /> ■ 2-inch ❑ 4-inch ❑ 6-inch ❑ Other ❑ Submersible ❑ Submersible Whale <br /> Total Depth of Casing(TD in feet BTOC) Jq�- 7 Y ❑ Other <br /> Water Level Depth(WL in feet BTOC) `i L 6 L Pump Intake Setting <br /> Number of Well Volumes(#Vols)to be Purged <br /> 3 ❑ 4 ❑ 5 ❑ Other ❑ Near Bottom ❑ Near Top ❑ Other <br /> Depth in feet(BTOC) <br /> Purge Volume Calulation Screen Interval in Feet(BTOC) from 52 <br /> '7q 6 b _ 2 2 to 77 <br /> TO(feet) AWL({feet) X X 3 X 00409 = gS gallons <br /> t](inches) #Vols Calculated Purge Volume <br /> Pump Time JPurge Rate Actual Purge Volume <br /> Start Z // Stop Time Elapsed Initial gpm Cl gallons <br /> Field Parameter Measurements Final gpm <br /> Time Gallons Purged DO% DO(mg/L) Cond 1 Cond 2 Salinity Temp pH Notes <br /> (umhos/cm) (umhos/cm) <br /> Observations During Purging(well Condition,Turbidity,Color,Odor etc <br /> Purge Water Storage/Disposal ❑ Drum(s),Number - El storm sewer ❑ Sanitary Sewer <br /> Other/Comments Purge water contained in ors-site 1,000 gallon poly tank pending analysis/disposal <br /> WELL SAMPLING <br /> Sampled By ISampling Date 12-110 03 _ ISampling Time �, —rd Z� <br /> Sampling Method Water Level Before Sampling(in feet BTOC) <br /> ❑ Baiter-Type ❑ Same as Above <br /> ❑ Submersible ❑ Whale ❑ Grab-Type <br /> ❑ Other ❑ Other-Type <br /> Isampling Distribution — Sample series – <br /> Sample No—__ Containers,Vol # - '_ Analysis_ '-- Preservative i-' Lab Comments <br /> ! I <br /> IOther Notes <br />