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IB�rJ EnvironmentallKnnagement,Inc GROUNDWATER SAMPLING FORM <br /> 202 East Earii Drive,Suite 478 <br /> I Phoenix,Arizona 850I2 Well NO W :1 <br /> 602 728 0707 <br /> Well © Monita ❑ Remedial -VE AS Recovery <br /> • Site ID Well PVC I] St Steel El Other <br /> Project No Date Time <br /> Recorded By Sampled By <br /> WELL PURGING <br /> FCasing <br /> Volume Purge Date Purge Method <br /> Diameter(D)to inches T El Bailer-Type <br /> 2 inch ❑ 4-inch ❑ 6-inch ❑ Other ❑ Submersible ❑ Whale <br /> 1f Total Depth of Casing (TD in feet BTOC) ❑ Other <br /> Water Level Depth(WL in feet BTOC) Pump Intake Setting <br /> Number of Well Volumes(#Vols)to be Purged <br /> ❑ <br /> ❑ 3 [:14 ❑ 5 El Other Near Bottom ❑ Near Top ❑ Other <br /> Depth in feet(BTOC) <br /> Purge Volume Calulation Screen Interval to Feet(BTOC) from <br /> 9 q5 — y X 2 X X 0 0409 to <br /> TD feet WL fest gallons <br /> ( ( ) D(inches) #Vols Calculated Purge Volume <br /> IPump Time Purge RateI lActual Purge Volume <br /> Start Stop Time Elapsed Initial gpm gallons <br /> Field Parameter Measurements Final gpm <br /> Time Time Lapsed Gallons Cond 1 Cond 2 <br /> P Purged (umhoslcm) (umhoslcm) Temp pH Nates <br /> i <br /> I <br /> Observations During Purging(well Condition,Turbidity,Color, Odor,etc <br /> I <br /> Purge Water Storage/Disposal ❑ Drum(s), Number [] Storm Sewer ❑ Sanitary Sewer <br /> Other <br /> WELL SAMPLING <br /> Sampling Date Sampling Time <br /> ISampling 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 Distributton Sample Series <br /> Sample No Containers,Vol,# Analysis Preservative Lab Comments <br /> Other Notes <br />