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• DOMESTIC/MUNICIPAL PROGRAM <br /> WELL SAMPLING DATA SHEET <br /> Address: J 3 J YK*n'"'JDate: 6A9/!Z <br /> Well ID: Purge Start Time: / Z . 00 <br /> Collected By: Purge End Time: I 0 <br /> Total Depth(feet): Sampling Time: t <br /> .. <br /> Screen Length(feet): Purge Sample Rate: <br /> Casing Diameter(inches): Total Purge Volume(I :7t� <br /> Conductivity Temperature <br /> Gallons Purged pH (us/cm) (Y) Other <br /> -70 -76 5o C(nod v OZ ty A j te Ive b Q 6 <br /> • <br /> Comments: l r d \ <br /> Wet I (oca4i0Y-. �/ � 5��e �' op Aeb vldr <br /> tt,p, vieI/ <br /> Field Certification: d Date <br /> Signe <br /> • <br />