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i <br /> IBLA- EI Emironmenral Maingentent We GROUNDWATER SAMPLING FORM <br /> 202 East Enrrl Dn.e Su rte 478 <br /> Phoenix Arizona 85012 Well No � S <br /> 1601171,8 0707 <br /> Well PC Monit Remedial-VE AS <br /> Site 1D 20q SD Well PV St Steel ❑ Other <br /> Protect No _j)L5 Z 1026n O Date_3 -/Gf -D! Time /_5"ZS <br /> Recorded Sampled By <br /> WELL PURGING <br /> I FX2-jnch <br /> e Volume Purge Date �j-7� .p Purge Method <br /> g Diameter(D)In OrIaller-Type <br /> ❑ 4 inch ❑6-inch ❑ Other f]Submersible ❑ Whale <br /> Total Depth of Casing JD in feet ❑ Other <br /> I Water Level Depth(WL In feet BTOC) Pump Intake Setting <br /> Number of Well Volumes(#Vols)to be <br /> ❑ Near Bottom ❑ Near Tap El Other <br /> 3 [:14 ❑ 5 El Other <br /> I Depth In feet <br /> Purge Volume Screen Interval In Feet(BTOC) <br /> r �p Z 2 <br /> ( 86-Go 7W 07� X X 3 X 0 0409 T 2O r?� to_ gallons <br /> I ` TD(feet) WL D(Inches) k vols Calculated Purge <br /> Pump Time I Purge R jActual Purge <br /> Volume <br /> Start Stop 60Time>=lapsed f- Inrtial ppm Z{0 gallons <br /> Field Parameter Measurements Final ppm <br /> Time Time Lapsed Gallons Temp pH Notes <br /> Purged (umhoslcm) (umhos/cm) <br /> z30 3�•d'/ 3 �/ Zt•S <br /> Observations During Purging(well Condition Turbidity Color Odor <br /> IPurge Water '% Drum(s) ❑ Storm Sewer ❑ SanitarySewer <br /> Other <br /> I WELL SAMPLING <br /> Sampling Date Sampling Tlme 17 <br /> Sampling MGthod Water Level Before Sompling On feet BTOC) �p <br />' Baiter-Type ❑ Some as Above <br /> El Submersible ❑Whale ❑ Grab-Type <br />' 0 Other ❑ Other-Type <br /> Sampling Dlstnbution Sample Series <br /> Sample No Containers Vol # Analysis Preservative Lab Comments <br /> —030 <br />' Other Notes <br /> 1 " <br />