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® DOMESTIC/MUNICIPAL PROGRAM <br /> WELL SAMPLING DATA SHEET <br /> 06 5c <br /> Address: -7 Q Date: t <br /> Well ID: Purge Start Time: r <br /> Collected By: r. Purge End Time: <br /> �® <br /> Total Depth(feet): Sampling Time: <br /> Screen Length(feet): Purge Sample Rate: l�L <br /> Casing Diameter(inches): J/ Total Purge Volume(E 0 <br /> Conductivity Temperature <br /> Gallons Purged pH (us/cm) (°C) Other <br /> auo� hJ i,;4� ,rd✓1 <br /> omments: <br /> Field Certification: I <br /> Signed Date <br />