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IBLAU Environmental Management,Inc GROUNDWATER SAMPLING FORM <br /> 202 East Earll>lrive,Suite 478 <br /> Phoenix,Arizona 85012 Well No w Z A <br /> 602 728 0707 <br /> • Well © Monito 0 Remedial-VE AS Recovery Site ID _ Well 0 PVC El St Steel 0 Other <br /> Project No �, Date_j, Time <br /> Recorded By ' Sampled By <br /> WELL PURGING <br /> Purg3—vol ume Purge Date I-L—C, >� Purge Method <br /> Casing Diameter(D)in inches ❑ Bailer-Type <br /> 1�12-inch Cl 4-Inch ❑ 6-inch ❑ Other Submersible ❑ Whale <br /> Total Depth of Casing (TD in feet BTOC) `��- ] Other <br /> Water Level Depth(WL in feet BTOC) 3 K Pump Intake Setting <br /> Number of Well Volumes(#Vols)to be Purged <br /> 1$ 3 ❑ 4 ❑ 5 ❑ Other K Near Bottom ElNear Top ❑ Other <br /> Depth in feet(BTOC) <br /> Purge Volume Calulabon Screen Interval in Feet(BTOC) from <br /> ff 2 to <br /> X Z X 3 X 0 0409 = 1y. l gallons <br /> TQ(feet) WL(feet) JJJ D(inches) #Vols Calculated Purge Volume <br /> Pump Time Purge Rate Actual Purge Volume <br /> Start ID ,6_ Stop -�0 Time Elapsed Initial gpm 5 gallons <br /> Field Parameter Measurements Final ppm <br /> Time Time Lapsed sed Gallons Cond 1 Cond 2 <br /> p Purged (umhoslcm) {umhoslcm} Temp 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 y L�-2—tV Sampling Time <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 Containers Vol # Analysis Preservative Lab Comments <br /> 1411 Ilk)- 2- _ 100 !- <br /> Other Notes <br />