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• DOMESTIC/MUNICIPAL PROGRAM <br /> WELL SAMPLING DATA SHEET <br /> �^ �� � <br /> Address: )Q /Q.?,_q Date: 14 A 7 <br /> Well ID: _ Purge Start Time: y <br /> Collected By: and Purge End Time: I� <br /> Total Depth(feet): Sampling Time: S <br /> Screen Length(feet): Purge Sample Rate: .0 9f an <br /> Casing Diameter(inches): Total Purge Volume(E SO <br /> Conductivity Temperature <br /> -T- <br /> Gallons Purged pH (us/cm) ('C) other <br /> a3.9 c - 4w k d,0-6 <br /> Comments: G t'a1b -� �5av-LK LtjL-S OC c}-{,L hOLZS eIlry(il(� <br /> le 6 wd�� <br /> Field Certification: ` ro/I L ` <br /> Signe Date <br /> • <br />