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1 <br /> BLAES Environmental Management,Inc GROUNDWATER SAMPLING FORM <br />' 1433 North Third Avenue <br /> Phoenrx,Arizona 85003 Well No MW-12B <br /> 6112-728-0767 <br /> Well Type ■ Monitor ❑ Remedial-VE AS <br /> IW'SitelD- U-Haul #709-50 ❑ Other <br /> Project No 002-70950-04 Well Material ■ PVC ❑ St Steel <br /> Recorded By Greg Coffin <br /> I <br /> — •• � El Other <br /> WELL PURGING <br /> Purge Volume Purge Date 12-1 p 3 Purge Method <br /> Casing Diameter(D)in inches T ® Bailer-Type <br /> 2-inch ❑ 4-inch ❑ 6-inch ❑ Other <br /> ❑ Submersible ❑ Submersible Whale <br /> Total Depth of Casing(TD in feet BTOC) - y 4 -'V ❑ Other <br /> Water Level Depth(WL in feet BTOC) '77- t7 Pump Intake Setting <br /> Number of Well Volumes(#Vols)to be Purged <br /> ❑ <br /> 3 [:14 ❑ 5 1:1 ether Near Bottom El Near Top El Other <br /> I Depth in feet(BTOC) <br /> Purge Volume Calulation Screen Interval in Feet(BTOC) from 40 <br /> 2 to 60 <br /> { TD(feet) WL(Feet) X D(inches) X #vols X Q 0409 = / `r gallons <br /> ` Calculated Purge Volume <br /> Pump Time Purge Rate Actual Purge Volume <br />' Start Stop Time Elapsed Initial gpm gallons <br /> Field Parameter Measurements Final gpm <br /> I Time Gallons Purged DO% DO(m 1L Cond 1 Cond 2 <br /> g ) (umhoslom) (umhoslcm) Salinity Temp pH Notes <br /> v0 7 <br /> I Observations During Purging - -- 4 - - - - <br /> g g(well Condition,Turbidity, Color Odor,etc <br /> Purge Water StoragelDisposal ❑ 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 /> 11�Sampled_dy_7 - Sampling Date /'/a/OF ISampling Time <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 /> Sampling Distributioil-7 Sample Series -_ — -- -- <br /> Sample No I Containers Vol # I Analysis — Preservative Lab r Comments <br /> _ f I <br /> Other Nates <br />