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ADDRESS O <br /> APN 00 SU# <br /> PERC TEST PARCEL DEPTH PERC RATE <br /> DATE OR LOT# (feet) (minlinch) COMMENT <br /> DATE SAMPLED TYPE OF WELL NITRATE mglL DBCP uglL EDB uglL COMMENTS(other address for well sampled) <br /> NITRATE LOADING <br /> RESULT(mglL-N) SR#: SR SR Date: <br />