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ADDRESS 1 I b(;,a W , a k ,.,o LY,,, PA # W I '� <br />APN SU# LVI k <br />PERC TEST PARCEL Perc DEPTH PERC RATE <br />DATE OR LOT # Hole # (feet) (min/inch) COMMENTS (PASS/FAIL) <br />DATE SAMPLED I YPE OF WELL NI I KA I E mg/L Db(;F ug1L EUb ug/L LUmmtN 10 Coiner auuress ror weu sampieu/ <br />NITRATE LOADING �q <br />RESULT (mg/L - N) r%„ A"4 SR #: SR SR Date: <br />