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• <br />Address: <br />Well ID: <br />Collected By: <br />Total Depth (feet): <br />Screen Length (feet): <br />Casing Diameter (inches): <br />• <br />0 <br />DOMESTIC/MUNICIPAL PROGRAM <br />WELL SAMPLING DATA SHEET <br />3"14--1 S: ,^" Qg=j Date: b I j G 11-7 <br />Purge Start Time: 1 moi- S� <br />�T I WGA► Purge End Time: <br />Sampling Time: <br />Purge Sample Rate: <br />Total Purge Volume (E <br />Gallons Purged <br />pH <br />Conductivity <br />(us/cm) <br />Temperature <br />('C) <br />Other <br />5� <br />Z�� <br />► oa <br />24.110 <br />Comments: <br />Field Certification: <br />Signed Date <br />