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DOMESTIC/MUNICIPAL PROGRAM <br /> WELL SAMPLING DATA SHEET f <br /> � l ?J <br /> Address: // add �tQ Date: <br /> Well ID: Purge Start Time: / d <br /> Collected By: Purge End Time: j S <br /> Total Depth(feet): Sampling Time: <br /> Screen Length(feet): MIA— Purge Sample Rate: a _ <br /> Casing Diameter(inches): 6,f Total Purge Volume(E <br /> Conductivity Temperature <br /> Gallons Purged pH (us/cm) ('C) Other <br /> e e !pe W <br /> omments: Lae <br /> locoAw\ 61 Pe p + e-A vtc e <br /> p hov s� l P oas r4c, mols+- <br /> Field Certification: AJ F - <br /> Signed Date <br />