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ADDRESS PA# <br /> APN � `�� SU# <br /> PERC TEST PARCEL Perc DEPTH PE;RC RATE j <br /> DATE OR LOT# Hole# (feet) (minlinch) COMMENTS ` <br /> E . <br /> DATE SAMPLED TYPE OF WELL NETRAT£mglL DBCP ug1L EDB uglL COMMENTS(other address for well sampled) <br /> } <br /> 1i <br /> NITRATE LOADING <br /> RESULT(mg1L N) SR#: SR ' SR-Date: <br />