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BLAE7 EnY�ronmental Management,[nc GROUNDWATER SAMPLING FORM <br /> 202 East Earl]Drive,Suitt 478 <br /> I Phoem,Arizona 85012 Well No W -�/� <br /> 602 728-0707 �1 <br /> • Site ID Well Monito E3 Remedial -VE AS Recovery <br /> Well PVC 0 St Steel © Other <br /> Project No ,�' Date Time <br /> Recorded By <br /> Sampled By <br /> WELL PURGING <br /> Purge Volume JPurge Date Purge Method <br /> Casing Diameter(D)in Inches ❑ Bailer-Type <br /> ❑ 2-Inch ❑ 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) Pump Intake Setting <br /> Number of Well Volumes(#Vols)to be Purged <br /> ❑ <br /> ❑ 3 ❑ 4 ❑ 5 ❑ Other Near Bottom El Near Top El Other <br /> Depth in feet(BTOC) <br /> Purge Volume Calulabon Screen Interval in Feet(BTOC) from <br /> 401 , 5� q� 'cb3 x 2 X X 00409 = to <br /> TO(feet) WL(feet) D(inches) #Vols gaIIORS <br /> Calculated Purge Volume <br /> Pump Time Purge Rate Actual Purge Volume <br /> Start Stop Time Elapsed Initial gpm gallons <br /> Field Parameter Measurements Final Ppm <br /> Time Time Lapsed Gallons Cond 1 Cond 2 <br /> Purged (umhos/cm) (umhos/cm) Temp pH Nates <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 -00 Sampling Time ( 2 = TS <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 /> Other Notes <br />