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�ILLD RECORD of WATT& SAMPLE <br /> WELL O& SAMPLE N0./I0 int �Ol MUfOtls•/S��Y O0�-OY-3 <br /> DEIm of WELL Sl: o CLIENT: /I��^�'t�' <br /> Mfr <br /> `�• DIAMETER CASING LOCATION: !'�� �•- ` <br /> ' WELL ELEVATION: SAMPLED BT: <br /> PERFORATED INTTRVAL__ TO <br /> METHOD OF EVACUATION <br /> I I WATER LEVEL I GALLONS REMOVED DURING EVACU- I <br /> DATE TIME BEFORE EVACUATION AIION OR PRIOR TO SAMPLING <br /> 011- <br /> .. <br /> I I I <br /> I I <br /> ' METHOD OF SAMPLINC <br /> DATE OF SAMPLE /•3/ TIME /Z ra <br /> DEPTH OF SAMPLE DOMESTIC WELL SANK _TES NO <br /> CONTAINER TTPES ANALYSIS <br /> (-A TEMP. /�1//P3�Id. 1 <br /> COFDUCTIVITY Q //�� 1/90 <br /> MCOtIENTS: Os x /52 /r✓ / J`1 L/r <br /> 1 <br />