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PA# <br /> ADDRESS <br /> APN GYJi �6 O SU# <br /> PERC TEST PARCEL Perc DEPTH PERC RATE L <br /> DATE OR LOT# Hole# (feet) (minlinch) COMMENTS <br /> DATE SAMPLED TYPE OF WELL NITRATE mglL DBCP uglL EDB uglL COMMENTS(other address for well sampled) <br /> NITRATE LOADING SR#: SR SR Date: <br /> RESULT(mg/L-N) <br />