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B[A* E Envtronmenlal titans ement,Inc <br /> t; GROUNDWATER SAMPLING FORM <br /> I433\Drib Third avenue <br /> ' IItocm>„Arizona 85003 Well No <br /> ,2-739-0707 <br /> ite ID U-Haul #709-50 <br /> Well Type ■ Monitor ❑ Remedial -VE AS <br /> D Other <br /> ' Prolecl No 002_70950_(,1,3' c.'-tWell Material ■ PVC El St Steel <br /> Recorded By M Hllstrom C1 Other <br /> ' l WELL PURGING <br /> Purge Volume r <br /> g _ Purge Date I _-2.6-6 Z Purge Method <br /> � <br /> CIS Diameter(D)In ruches Bailer-Type l � <br /> . 5 <br /> ' 2-inch ❑ 4-inch ❑ 6-inch ❑ Other <br /> Submersible ❑ Whale <br /> it",Depth of Casing(TD in feet BTOC) ❑ Other <br /> Water Level Depth(WL in feet BTOC) <br /> ' erPum{ Intake Setting � <br /> of Well Volumes (#Vols)to be Purged <br /> El ❑ ❑ <br /> 4 S Other ❑ Hear Bottom El Near Top <br /> X <br /> Depth in Feet (BTOC) Other <br /> Purge Volume Calulation Screen Interval in Fe`eti(BTOC) from <br /> 1�0 -- S X 'Z 2 X - X 0 0409 1 1 . 1 5 to <br /> TD(feet) WL(feet) D(inches) #Vols gallons <br /> Calculated Purge Volume <br /> Ramp Time Purge Rate Actual Purge Volume <br /> StartlW Stop Time Elapsed Initial qpm Z gallons <br /> Field Parameter Measurements Final qpm <br /> Time Time lapsed Gallons Gond 1 C and 2 <br /> Purged (umhaslcm) {umhoslcm) Temp pH Nates yj f <br /> tObservations During Purging(well Condition,Turbidity Color Odor etc <br /> Purge Wat Storag 19#6fMa i— ❑Drum(s),Number Storm Sewer <br /> ' ❑ El Sanitary Sewei <br /> then 000 a � 6 rJiTz <br /> WELL SAMPLING <br /> Sampled By M Hllstrom Sampling Date — 7-p Z. Sampling Time <br /> Sampling Method Water Level Before Sampling(in feet BTOC) nr <br /> N Bader-Type 3 #t Disposable ❑ Same as Above <br /> ❑ Submersible <br /> ❑ Whale El Grab-Type <br /> ❑ Other ❑ Other-Type <br /> Sampling Distribution Sample Senes <br /> Sample No Containers,Vol,# Analysis Preservative Lab Comments <br /> Dbo Z o rK c)(5 rej 1V4 <br /> ' €301501 <br /> ' Other Notes <br />