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iy' <br />ADDRESS Z -'IS 3 Q, 0 �a Ate. sT�� �� . PA # <br />APN q"L 7c, - \ �� 6 `5 SU# <br />PERC TEST PARCEL Perc DEPTH PERC RATE <br />DATE OR LOT # Hole # (feet) (min/inch) COMMENTS (PASS/FAIL) <br />DATE SAMPLED TYPE OF WELL NITRATE ma/L DBCP ua/L EDB ua/L COMMENTS (other address for well sampled) <br />NL IALL <br />Q <br />NO <br />0,kO H N- <br />G <br />(TRATE LOADING <br />ESULT (mg/L - N) `'L. -'I 3 SR #: SR SR Date: <br />a <br />