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ADDRESS I � YZ� q+� PA# 't Zl y (Al <br /> APN 2- L)70 3 5 SU# r <br /> PERC TEST PARCEL Perc DEPTH PERC RATE ti rg 4'E <br /> DATE OR LOT# Hole# (feet) f^ ' <br /> ( ) (min/inch) COMMENTS <br /> DATE SAMP ED TYPE OF WELL NITRATE mg/L DBCP ug/L ED8 ug/L COMMENTS(other address for well sampled) <br /> NITRATE LOADING ------ _ <br /> RESULT(mg/L-N) SR #: SR -- SR Date: �— <br />