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• <br />• <br />0 <br />DOMESTIC/MUNICIPAL PROGRAM <br />WELL SAMPLING DATA SHEET <br />Address: J911- Sv 1r'ltny R4i Date: <br />Well ID: �t Purge Start Time: <br />Collected By: A -T I k—A Purge End Time: <br />Total Depth (feet): <br />Screen Length (feet): <br />Casing Diameter (inches): <br />Sampling Time: <br />IC=k 1T- <br />IlOGI <br />i1c12 <br />tip VS <br />Purge Sample Rate: Z -CS �'-1� + rvrnYl <br />Total Purge Volume (g <br />Gallons Purged <br />pH ]::(us/cm) <br />Conductivity <br />Temperature <br />('C) <br />Other <br />Comments: <br />Field Certification: tQa�4 ff-, 11-1 <br />Signed Date <br />