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1.WELL CONTRACTOR: d.TW OF CASfMS W __FT.Abase LardSWbW
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SITE WELL ID#(ifaMirml e - Fran To Ft_
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DATE DRILLED FoM—To FL
TUIECOMPLETED AMO PNO 8. Sty Dew olamdw Stage Material
4.WELL LOCATION: l� To Fter- in
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TOPOGRAPNO 1 LAND SETIM: 080sba malem
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NAME OF FACMY
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a TOTAL DEPTH:-- l oZ s rmnotm Pr OMEDTO rrE awrrm
' b. DOES WELL REPLACE EASTM WELL? YEW NOV _ J/ '�
R WATER IMEL Belna�Top of Casir6 'J D Fr.
SiG�IA OF CONTRACTOR 7E
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PRKrED NAME OF PERSON CON57RUC'TNG im WELL
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