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• <br />.7 <br />0 <br />DOMESTIC/MUNICIPAL PROGRAM <br />WELL SAMPLING DATA SHEET <br />Address: 2..(� <JA Date: Ce�Z1 "j <br />Well ID: " Purge Start Time: <br />Collected By: T kld. Purge End Time: iAS <br />Total Depth (feet): Sampling Time: <br />Screen Length (feet): Purge Sample Rate: <br />Casing Diameter (inches): Total Purge Volume (t .�i•l <br />Gallons Purged <br />pH <br />Conductivity <br />(us/cm) <br />Temperature <br />('C) <br />Other <br />Comments: <br />Field Certification: <br />Signed 6ate <br />