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BLACJ GROUNDWATER SAMPLING FORM <br /> 202 EaS1 Enrli Drive Suite 478 /J <br /> Phoenix Arrzonp 83012 Well No <br /> I (602)728 0707 <br /> Well R-Monit O Remedial-VE AS <br /> Site ED 704'�� Well PV © St Steel 11 Other <br /> ProJect No BO Z lay Soo Z Date-Z �cr-b� Time <br />' Recorded r Sampled By <br /> WELL PURGING <br /> Purge Volume Purge Date 3--7.0 ,O ) Purge Method <br /> Cos,ng Diameter(D)in ❑ Bailer-Type <br /> ❑2-Inch ?q 4-Inch ❑ 6-inch ❑ Other Submersible ❑Whale <br /> Total Depth of Casing(TD in feet ElOther <br /> Water Level Depth(WL In feet BTOC) Pump Intake Setting <br /> Number of Well Volumes(#Vols)to be <br /> 3 ❑4 ❑ 5 ❑ Other ❑ Near Bottom ❑ Near Top ❑ Other <br /> I Depth In feet <br /> Pu a fume $5 Screen interval in Feet(BTOC) <br /> 2 to <br /> To(feet} WL x o(inches) x v3OLS x 0 0409 30 . 3 3 gallons <br /> Calculated Purge <br /> Pump Time IPurge Rate Actual Purge Volume <br /> Start r?,(C) Stop 1155 Time Elapsed Initial ppm 3 Sr gallons <br /> I Field Parameter Measurements f=inal ppm <br /> Time Time Lapsed Gallons fCoyd'l Cp Purged ( stcm) (u hos/cm) Temp pFiNotes <br /> Observahons During Purging(well Condition Turbidity Color Odor <br /> Purge Water Drum(s)U ❑ Storm Sewer ❑ Sanitary Sower <br /> Other <br /> WELL SAMPLING <br /> Sampling Date Zf O/ Sampling Time z ` S <br /> Sampling Method Water Level Before Sampling(in feet BTOC) 5 <br /> Boiler-Type El Some as Above <br /> Submersible El Whole El Grab-Type <br /> Other ❑ Other-Type <br /> Sampling Distribution Sample series <br /> Sample No Contains Voi ffi Analysis Preservative Lob Comments <br /> 3 ra 1/0 As <br /> Other Notes <br />