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BLAE1EnvlronmentalManagement,Inc GROUNDWATER SAMPLING FORM <br /> 202 East Earll Drive,Suite 47B <br /> I Phoenix,Arizona 85012 Well No <br /> (602172 3-0707 ❑ <br /> Well onito ❑ Remedial-VE AS Recovery <br /> Site ID Well /© PVC 0 St Steel 0 Other <br /> Project No�� �.,� ? Date ' -to--00 Time <br /> Recorded By Sampled By <br /> I WELL PURGING <br /> Purge Volume Purge Date Purge Method <br /> Casing Diameter(D)in inches ❑ Bader-Type <br /> [g 2-inch ❑ 4-inch ❑ 6-inch ❑ Other Submersible ❑ Whale <br /> Total Depth of Casing(TD in feet BTOC) I [ Other <br /> Water Level Depth(WL in feet STOC) fpump Intake Setting <br /> Number of Well Volumes(#Vols)to be Purged <br /> ❑ 4 [-15 ❑ Other ❑ Near Bottom ❑ Near Top ❑ Other <br /> Depth in feet(BTOC) <br /> Purge Volume Calulation Screen Interval in Feet(STOC) from <br /> I 7 t�'10 _ X ,_,L 2 3 to <br /> TD(feel) WL(feet) D(inches) X #vols X 0 0409 = gallons <br /> Calculated Purge Volume <br /> Pump Time IPurge Rate JACtual Purge Volume <br /> Start Y�T I S Stop Time Elapsed Initial gpm <br /> S gallons <br /> IField Parameter Measurements Final Qpm <br /> Time Time Lapsed Gallons Cond 1 Cond 2 <br /> p Purged (umhos/cm) (umhos/cm) Temp pH Notes <br /> I <br /> Observations During Purging(well Condition,Turbidity,Color, Odor etc <br /> Purge Water Storage/Disposal Drum(s), Number ❑ Storm Sewer ❑ Sanitary Sewer <br /> Other <br /> WELL SAMPLING <br /> Sampling Date I I-L— ISampling Time Gj V <br /> Sampling Method Water Level Before Sampling(in feet BTOC) ^^ <br /> Bailer-Type ❑ Same as Above <br /> Submersible ❑ Whale ❑ Grab-Type <br /> ❑ Other ❑ Other-Type <br /> Sampling Distribution Sample Series <br /> Sample No Cont finers Vol ,# Analysis Preservative Lab Comments <br /> r- -I w{� <br /> chi <br /> Other Notes <br />