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ADDRESS � �� Al �iL/�h �GJ PA# - rl--CO�gd <br /> APN Z 6I bo0 ' 7.4 2S -SU# <br /> PERC TEST PARCEL Per. DEPTH PERC RATE <br /> DATE OR LOT# Hole# (feet) (minleinch) COMMENTS(PASS/FAIL) <br /> ( ( // ZD <br /> DATE SAMPLED TYPE OF WELL NITRATE mg/L DBCP ug/L EDB ug—COMMENTS(other address for well sampled) <br /> e✓ <br /> NITRATE LOADING �J /L?Z <br /> RESULT(mg/L-N) SR#: SR QO /D SR Date: <br />