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• DOMESTIC/MUNICIPAL PROGRAM <br /> WELL SAMPLING DATA SHEET' <br /> Address: �5y F. ("a«"'%ate: <br /> Well ID: Purge Start Time: !`1 <br /> Collected By: Purge End Time: <br /> Total Depth(feet): Sampling Time: �` s <br /> Screen length(feet): Purge Sample Rate: <br /> Casing Diameter(Inches): Total Purge Volume(@ <br /> Conductivity Temperature <br /> Gallons Purged pH (us/cm) ('c) Other <br /> • <br /> Comments: t5 d v4+n W C--r- <br /> oCga-con <br /> by k+t uwe11 , Ind 4o ,yAr4to, to hov- oe �-k <br /> � . <br /> Field Certification: <br /> Signed Date <br /> i�- Jet S cold <br />