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A75 <br /> BUS 1[11gemenr Inc GROUNDWATER SAMPLING FORM <br /> • M) niN Ertl io 8 Su+tc 478 <br /> Plrocm2 X707 8n01? Well No <br /> (602l 728 0707 <br /> Site ID _�OaS� Well Monit ❑ Remedial-VE AS <br /> _ Well ❑ PV 0 St Steel ❑ Other <br /> Project No Date Time <br /> IRecorded Sampled By <br /> WELL PURGING <br /> Purge Volume Purge Date Purge Method <br /> Casing Diameter(D)in _ ❑ Bailer-Type <br /> ❑ 2-Inch ❑ 4-inch ❑ b-inch ❑ Other ❑ Submersible ❑ Whale <br /> Toto!Depth of Casing(TD in feet ❑ Other <br /> I Water Level Depth(WL in feet BTOC) Pump Intake Seating <br /> Number of Well Volumes(ft Vols)to be <br /> ❑3 ❑4 ❑ S ❑ Other ❑ Near Bottom ❑ Near Top ❑ Other <br /> Depth In feet <br /> Purge Volume Screen Interval In Feet(BTOC) <br /> _ 2 to <br /> TD(feet) WL X D(Inches) X n vols X 0 0409 gallons <br /> Calculated Purge <br /> Pump Time Purge Rate Actual Purge Volume <br /> Start Stop Time Elapsed Initlal ppm gallons <br /> Field Parameter Measurements Flnot Qpm <br /> Tlme Time Lapsed Gallons Cond 1 Cond 2 <br /> Ip Purged (umhoslcm) (umhos/cm) Temp PH Notes <br /> Observations During Purging(well Condition Turbidity Color Odor <br /> Purge Water Drum s <br /> C) El Storm Sewer ❑ Sanitary Sewer <br /> Cher <br /> WELL SAMPLING <br /> Sampling Date 31`7Y/O Sampimg Time Z� <br /> I Sampling Method Water Level Before SompMg(on feet BTOC) <br /> 117 Boiler-Type ❑ Some as Above <br /> bmersibie ❑ Whale ❑ Grob-Type <br /> Other ❑ Other-Type <br /> Sampling Distribution Sample Series <br /> Sample No Containers Vol # Analysis Preservative Lab Comments <br /> Other Notes <br />