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DOMESTIC/MUNICIPAL PROGRAM <br /> WELL SAMPLING DATA SHEET <br /> Address: 61 q117 <br /> Well ID: Purge Start Time: , <br /> Collected By: _ � -Purge End Time: I <br /> Total Depth(feet): Sampling Time: <br /> Screen Length(feet): Purge Sample Rate: . <br /> Casing Diameter(inches): Total Purge Volume(E <br /> Conductivity Temperature <br /> Gallons Purged pH (us/cm) ('C) ther <br /> t f <br /> Comments: <br /> c ► 1 c5 I <br /> oky �,W+- Ao <br /> wmd <br /> Field Certification: /91! <br /> Signe Date <br />