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®DOMESTIC/MUNICIPAL PROGRAM <br />WELL SAMPLING DATA SHEET <br />Address: Date: <br />Well ID: Purge Start Time: 1 <br />3-70 <br />Collected By: AA P Purge End Time: 1 <br />Total Depth (feet). Sampling Throe: <br />Screen Length (feet): Purge Sample ' <br />Casing Diameter (inches): Toul Purge volume (1 <br />u <br />Gallons Pu PH (us/cm) (`� Other <br />Rerg: l c ,6r r <br />(` a� C <br />o c vicivt', Pwx <br />Field1 A <br />Certification: ` <br />Signed ®ate <br />0— <br />