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BLAU En�ironment�lMIringement Inc GROUNDWATER SAMPLING FORM <br /> SUS Blst Eriz wt S 12 178 <br /> 602)I'llue72 lnz7 8 013 Well No <br /> {603)7?9 0707 <br /> SiteID Well /ER-Monit ❑ Remedial-VE AS <br /> Well E3 PV [3 St Steel E:1 Other <br /> Pro}ect No Q7Z 7Q(j�D Z- Date '7,- p/ Time /A7.,/0 <br />■ Recorded e c-N 76 Sampled By <br /> IWELL PURGING <br /> Purge Volume JPUrge Date j —D Purge Method <br /> ICasing Diameter(D)in Baller Type <br /> 2-Inch [I4-inch [I6-Inch ❑ Other 11Submemble ❑Whale <br /> Total Depth of Casing JD In feet ❑ Other <br /> I Water Level Depth(WL In feet STOC) <br /> Number of Well Volumes(Ti Vols)to be <br /> Pump intake Setting <br /> 3 ❑4 ❑ 5 ❑ Other &Near Bottom ❑ Near Top ❑ Other <br /> Depth In feet <br /> IPurge Volume Screen Interval In Feet(BTOC) <br />` 75TO-% — 3 X Z 2 to <br /> X S X 0 0409 'S <br /> I111 WL D(Inches) #Vols gallonsCalculated Purge <br /> PUMP Time Purge Rate Actual Purge Volume <br /> Start 133U Stop 143 Time Elapsed Initial,�� Qpm gallons <br /> ieid Parameter Measurements Final Qpm <br /> 3 <br /> Time Time Lapsed Gallons Co Cond <br /> Purged (u oslcm) (um s/cm) Temp pH Notes <br /> I <br /> I <br /> Observations During Purging(well Condition Turb:dity Color Odor <br /> Purge Water Drum(s) <br /> El Storm Sewer ❑ Sanitary Sewer <br /> Other <br /> WELL SAMPLING <br /> Sampling Date Sampling Time / d p <br /> Sampling Method Water Level Before Sompling(In feet BTOC) 44e•-Z< <br /> Bailer-Type ❑ Some as Above <br /> Submersible ❑ Whale ❑ Grob-Type <br /> Other ❑ Other-Type <br /> Sampling Distribution Sample Senes <br /> Sample No Containers Vol 4 Analysis Preservative Lab Comments <br /> �fl3Q 1 <br /> Other Notes <br /> I <br />