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ADDRESS V PA# <br /> APN SU# _ <br /> PERC TEST PARCEL Pere DEPTH PERC RATE <br /> DATE OR LOT*. Hole# (feet) (minlinch) COMMENT <br /> DATE SAMPLED TYPE OF WELL NITRATE mg/L DBCP ug/L EDB ug/L COMMENTS(other address for well sampled) <br /> J <br /> NITRATE LOADING,- <br /> RESULT(mg/L-N) SR#: SR SR Date: <br />