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DOMESTIC/MUNICIPAL PROGRAM <br /> WELL SAMPLING DATA SHEET <br /> Address: fr Date: �.'2m! / <br /> Well ID: / Purge Start Time: <br /> Collected By: Y1+a Purge End Time: 0 <br /> Total Depth(feet): Sampling Time: / 3 <br /> Screen Length(feet): 1A Purge Sample Rate: Q <br /> Casing Diameter(inches): _ Total Purge Volume(E , <br /> Conductivity Temperature <br /> Gallons Purged pH (us/cm) ('C) other <br /> Com encs: <br /> 1r2 It t '�c� c��o� . i � ht5 GJeII ® h,,Ct 46 _S&Mfte <br /> clve.,�n. ob +�S Cause o+ 8ry j <br /> t t�`1 Sq toC04cor` tS r.ex { <br /> a.r <br /> Field Certification: ' �'l <br /> Signed Date <br /> 14 °A <br /> t oa 1 -<'has ®`sC, k re" ✓1 <br /> e4ky <br />