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® DOMESTIC/MUNICIPAL PROGRAM <br /> WELL SAMPLING DATA SHEET <br /> 6 Address: o 4l Date: I <br /> Well ID: Purge Start Time: IhQQ <br /> Collected By: Purge End Time: /d t q <br /> Total Depth(feet): Sampling Time: I /b <br /> Screen Length(feet): Purge Sample Rate: C® <br /> Casing Diameter(inches): ®r Total Purge Volume(g '7 h <br /> Conductivity Temperature <br /> Gallons Purged pH (us/cm) ('C) Other <br /> 5,,g n ?V ay. 94Tuf <br /> Comments: <br /> li.Jetl jOCCi�'PCI 5615<� tk�� <br /> Field Certification: �)b j <br /> Signed Date <br />