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BLA. Ff EnY�roennen],I AlanRsen,ei„ Inc GROUNDWATER SAMPLING FORM <br /> . 202 Fist Earl]Drive Suite 478 /�' <br /> Phn <br /> cen ikrtzon7 8 011 Well NO //0 <br /> (661)728 0707 <br /> Well 0 Monit © Remedial-VE AS <br /> Site ID Well ❑ PV ❑ St Steel❑ Other <br /> Project No_ 067-76 q S:v Date -( _Q Time /6 <br /> j Z <br /> Recorded r Sampled By <br /> WELL PURGING <br /> Purge Volume Purge Date Purge Mefhod <br /> Casing Diameter(D)In 'Boller-Type <br /> r2-Inch El4-InchEl &inch [IOther [ISubmersible EJ Whole <br /> fal Depth of Casing(13 In feet ❑ Other <br /> Water Level Depth(WL in feet BTOC) Pump Intake Setting <br /> Number of Well Volumes(#Vols)to be <br /> 3 ❑ 4 El 5 Near Bottom ❑ Near lop ❑ Other <br /> ❑ Other Depth In feet <br /> Purge Volume Screen Intervai In Feet(BTOC) <br /> ( 91,( — 4S.bS 3 <br /> X <br /> (feet) wL D(inches)2 X s vols X 0 0409 = 's to <br /> gallons <br /> Calculated Purge <br /> Pump Time Purge Rate Actual Purge Volume <br /> Start (Z 33 Stop IV-5r Time Elapsed Initial QPM gallons <br /> IField Parameter Measurements Final qpm <br /> Time Time Lapsed Gallons Con Cond 2 Tem <br /> Purged as/cm) (u slcm) p pH Notes <br /> Observations During Purging(well Condition Turbidity Color Odor <br /> Purge Water Drum(s) Storm <br /> ❑ Sewer ❑ Sanitary Sewer <br /> Other <br /> WELL SAMPLING <br /> Sampling D I 3 -27--O/ Sampling Time <br /> Sampling Methoc! Water Level Before Sampling(In feet BTOC) <br /> I Bailer-Type ❑ Some as Above <br /> ❑Submersible ❑ Whole ❑ Grab-Type <br /> I Other ❑ Other-Type <br /> Sampling Disfributtort Sample Series <br /> Sample No Contaloers Vol # Analysis Preservative Lob Comments <br /> Other Notes <br /> I <br />