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s f-u-&.' A4-� . WK� <br /> IBLAffEnvironmentalManagement,Inc GROUNDWATER SAMPLING FORM <br /> 202 East Earll brie,Suite 478 <br /> Phoenix,Arizona 85012 Well No <br /> I 602 728 0707 <br /> Well Monito © Remedial-VP AS Recovery <br /> Site ID Well © PVC © St Steel 0 Other <br /> IProject No Date L Time <br /> Recorded By Sampled By <br /> WELL PURGING <br /> Purge Volume JPurge Date Purge Method <br /> Casing Diameter(D)in inches 6iler-Type <br /> �,( 2-inch ❑ 4-inch ❑ 6-inch ❑ Other Submersible El Whale <br /> Total Depth of Casing (TD in feet BTOC) Q ,s ❑ Other <br /> Water Level Depth(WL in feet BTOC) Pump Intake Setting <br /> Number of Well Volumes(#Vols)to be Purged <br /> q3 ❑ 4 ❑ 5 E:1 Other Near Bottom ❑ Near Top El Other <br /> Depth in feet(BTOC) <br /> Purge Volume Calulation Screen Interval in Feet(BTOC) from <br /> '9 x 2 2 x -- x a o40 Z ,s to <br /> TD(feet) WL(feet) D(inches) #Vols 9 = gallons <br /> Calculated <br /> Purge Volume <br /> IPrimp Time Purge Rate Actual Purge Volume <br /> Start 9D Stop 15 Time Elapsed 35hw.n Initial s T 1 gpm gallons <br /> Field Parameter Measurements Final qpm <br /> Time Time Lapsed Gallons Cond 1 Cond 2 Tem <br /> Purged (umhos/cm) (umhoslcm) p pH Notes <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 'Z-{;r--ate ISampling Time <br /> Sampling Method Water Level Before Sampling (in feet BTOC) <br /> 91 Bailer-Type ❑ Same as Above <br /> ❑ Submersible ❑ Whale ® Grab-Type <br /> ❑ Other ❑ Other-Type <br /> Sampling Distribution I Sample Series <br /> Sample No Containers,Vol ,# Analysis Preservative Lab Comments <br /> Other Notes <br />