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® DOMESTIC/MUNICIPAL PROGRAM <br /> WELL SAMPLING DATA SHEET <br /> Address: Ps'~ Date: �/'7 <br /> Well ID: Purge Start Time: ju 1 5 <br /> Collected By: ­T-o4v Purge End Time: W1 t} <br /> Total Depth(feet): AI Sampling Time: Cq 07 <br /> Screen Length(feet): e/,+ Purge Sample Rate: d •p <br /> Casing Diameter(inches): 10 <br /> r0 Total Purge Volume(g Ze <br /> Can uctivity Temperature <br /> Gallons Purged PH (us/cm) (°C) Other <br /> ko X.da (lea, fief <br /> Comments: Ctcu ® 1 e& c6 <br /> Field Certification: <br /> Signed Date <br />