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BLAS$ Egnronmental Management,Inc GROUNDWATER SAMPLING FORM <br /> 1433 North Third Avenue <br /> Phoenix,ArizOna 85003 Well No MW-1 C <br /> 602-728-0707 <br /> Well Type ■ Monitor 17 Remedial -VE AS <br /> I1wite ID —!!-Haul #709-50 ❑ Other <br /> Project No 002-70950-04 Well Material ■ PVC ❑ St Steel <br /> Recorded By Greg- ❑ Other <br /> WELL PURGING <br /> Purge Volume JPurge Date 1purge Method <br /> I Casing Diameter([))in inches ❑ Bader-Type <br /> 0 2-Inch ❑ 4-inch ❑ 6-inch ❑ Other ❑ Submersible ❑ Submersible Whale <br /> Total Depth of Casing(TD In feet BTOC) 4e$� Lo 0 ❑ Other <br /> Water Level Depth(WL in feet BTOC) _--'m g`� 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 f=eet(BTOC) from 75 <br /> Ck 2 to 100 <br /> 1( <br /> TD(feetwfee ) X 2 X 3 X 0 0409 = ~'cep q'Z gallons <br /> { ) D(inches) #Vols Calculated Purge Volume <br /> Pump Time Purge Rate Actual Purge Volume <br /> Start /y ZZ." Stop Time Elapsed Initial gpm ( gallons <br /> Field Parameter Measurements Final gpm <br /> Time Gallons Purged DQ% DO(mglL) (umhos/cm) (umhos/m) salinity Temp pH Notes <br /> {,t C_ & 77 0 -' <br /> i s 67-y C.': S- <br /> 7 ( U 7 G3, Li(? U > 7 <br /> 1 -z 'Z.r, �_t C) �/4> Lel e i rr e1 <br /> Observations During Purging(well Condition Turbidity,Color,Odor,etc <br /> i <br /> E Purge Water Storage/Disposal ❑ Drum(s),Number ❑ Storm sewer ❑ Sanitary Sewer <br /> Other/Comments Purge water contained In on-site 1,000 gallon poly tank pending analysis/disposal <br /> WELL SAMPLING <br /> Sampled By c _ Sampling Date 0- to o Sampling Time 7 <br /> Sampling Method Water Level Before Sampling(in feet BTOC) <br /> ❑ Bailer-Type ❑ Same as Above <br /> ❑ Submersible ❑ Whale ❑ Grab-Type <br /> ❑ Other ❑ Other-Type <br /> ISamplmg Distribution Sample Series <br /> Sample No I Containers,Vol,# Analysis I Preservative I Lab--� Comments <br /> IOther Notes <br />