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! ..rth <br /> Ef EnuronmentalManagement,in¢ GROUNDWATER SAMPLING FORM <br /> Third Avenue <br /> A ` L <br /> ' ^liacnn,Arizona 85003 Well No / <br /> it I �7 0 7 Well Type ■ Monitor C1Remedlat-VE AS <br /> Ite D U-Hou! #709-50 ❑ Other <br /> Protect No 002-70950-W,5 Well Material ■ PVC © St Steel <br /> Recorded By M HllstromJ f <br /> ❑ Other vo <br /> I WELL PURGING <br /> Purge Volume Purge DateZ�-fl R8aler-Typ,e <br /> ge Method <br /> Casing Diameter(D)in inches <br /> 2-inch ❑ 4-inch ❑ 6-inch ❑ Other <br /> El Submersible ❑ Whale <br /> Total Depth of Casing(TD in feet BTOC) ❑ Other <br /> Water Level Depth(WL to feet BTOC) <br /> Pump Intake Setting' �ja,�� ,� v Number of Well Volumes(#Vols)to be Purged El <br /> Near Bottom ❑ Near Top ][Other <br /> tbl 3 ❑ 4 [:1 5 F-1 Other Depth to feet(BTOC) <br /> ' Purge Volume Caiulation Screen Interval in Feet(BTOC) from <br /> p' } 2 = to <br />� O�v�� ���`��J X � -- X X Q Q409 �� gallons <br /> TD(feet) WL(feet) D(inches) #Vols Calculated Purge Volume <br /> ' Pump Time Purge Rate jActual Purge Volume <br /> Start 0_1% Stop 00.601 Time Elapsed Initial qpm •c- ! gallons <br /> ' — <br /> Field Parameter Measurements Final qpm <br /> Time Time lapsed Gallons Cond 1 Cond 2 Tem H Notes <br /> ' Purged (umhos/cm) (umhoslcm) p p <br /> i1 <br /> A01 '� f C{r [G I / r to <br /> 1 <br /> i <br /> Observations During Purging(well Condition Turbidity Color Odor etc z-Y— <br /> Purge Wat Stora Drepo531 ❑Drum(s), Number C Storm Sewer ❑ Sanitary Sewer <br /> ' Other 6 r - O P7 <br /> W Ll SAMPLING s <br /> ' <br /> D Z Sam Sampled By M Hllstrom Sampllrtg Date ��Z�- plmg Time <br /> Sampling Method I Water Level Before Sampling(in feet BTOC) <br /> Bailer-Type ft_ Disposable - ❑ Same as Above <br /> I1 � — e - <br /> ❑ Submersible ❑ Whale ❑ Grab-Type � <br /> ❑ Other Other-Type <br /> Sampling Distribution Sample Series <br /> Sample No Containers Vol ,# Analysts Preservative Lab Comments <br /> - 0 C - D A- 2 D 1Ajyk <br /> a� <br /> Uo -� <br /> ' Other Notes <br />