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0 DOMESTIC/MUNICIPAL PROGRAM <br /> WELL SAMPLING DATA SHEET <br /> �R d <br /> Address: t a �s y � �r Date: a�1� <br /> Well ID: Purge Start Time: 1b 17 <br /> Collected By: �01Mq Purge End Time: i d <br /> Total Depth(feet): Sampling Time: it, r� <br /> Screen Length(feet): Purge Sample Rate: 4.0 <br /> Casing Diameter(inches): Total Purge Volume(E O <br /> Conductivity Temperature <br /> Gallons Purged pH (us/cm) (10 Other <br /> 6 5,g b 1. 41 <br /> Comments: <br /> 11�J21( �occ��d t5 Sava-h S V� T►"� <br /> Nnele i n l o��►to f, So v �.�es�- Per 40 Alc S►d e ac Ai-io- h(AJ <br /> rieid Certification: <br /> Signed Date <br />