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BLAU Environmental Management,tine GROUNDWATER SAMPLING FORM <br /> 202 East Earl]Drive,Suite 478 <br /> Phoenix,Arizona 850I2 Well No <br /> 602 728-4707 <br /> Well Type B' Monitor El Remedial -VE AS Recovery <br /> Site 1D 5 - Sb Well Material W PVC El St Steel ❑ Other <br /> I Project No oo Z -7 o 5 So- o 2- Date 2L77/60 Time O 3 <br /> i Recorded By �j, Sampled By C. <br /> WELL PURGING <br /> Purge Volume Purge Date JPurge Method <br /> Casing Diameter(D)in inches ❑ Bailer-Type <br /> I Z'2-inch ❑ 4-inch ❑ 6-inch ❑ Other B Submersible*� ❑ Whale <br /> Total Depth of Casing JD in feet 13TOC) g .5 E] Other , Zu <br /> Water Level Depth(WL in feet STOC) $ pump Intake Setting <br /> Number of Well Volumes(#Vols)to be Purged N Near Bottom ❑ Near Tap El Other <br /> 3 E:1 4 E] 5 ❑ Other Depth in feet(BTOC) 'ti <br /> Purge Volume Calulation Screen Interval in Feet(BTOC) from <br /> U9- < — l z 3 to qQ <br /> ro creat wL rl X X X 0 0409 = /g� gallons <br /> ( 1 D(inches} #Vols Calculated Purge Volume <br /> Pump Time Purge RateActual Purge Volume <br /> Start Stop 104 Time Elapsed Initial gpm gallons <br /> !Field Parameter Measurements I <br /> Final gpm <br /> Gallons Cond t Cond 2 <br /> T] e C Time Lapsed Temp Notes <br /> rrs& � 3 Purged (umhoslcm) (umhoslcm) <br /> I <br /> Observations During Purging(well Condition,Turbidity,Color, Odor,etc <br /> 'H'.' f4uz <br />■■ Purge Water Storage/Disposal ❑ Drum(s),Number ❑ Storm Sewer ❑ Sanitary Sewer <br /> Other Q.4 {7IJf � L <br /> WELL SAMPLING <br /> Sampling Date Via ler) ISampling <br /> TiTime_ �d <br /> Sampling Method Water Level Before Sampling(in feet BTOC) 1 <br /> Bailer-Type LP J U _ Same as Above <br /> IN <br /> ❑ Submersible ❑ Whale ❑ Grab-Type <br /> ❑ Other ❑ Other-Type <br /> Sampling Distribution Sample Series <br /> Sample No Containers,Vol ,# Analysis Preservative Lab Comments <br /> y�ff I,i3� DO JJD woof g�, <br /> IOther Notes <br />