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ADDRESS PCACOD PA# <br /> APN �i(� �-� OS_ __ ob SU# <br /> PERC TEST PARCEL Perc DEPTH PERC RATE <br /> DATE OR LOT# Hole# (feet) (min/inch) COMMENTS(PASS/FAIL) <br /> DATE SAMPLED TYPE OF WELL NITRATE mg/L DBCP ug/L EDB ug/L COMMENTS(other address for well sampled) <br /> NITRATE LOADING / SR#: SR � C <br /> RESULT(mg/L-N) l � ' SR Date: <br />