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<br /> 1 6TATC Or GAUFO01v1A ' DO not Jill
<br /> tIPr'-, CCobpwner s _}3y THE REN�. 100075
<br /> SOURCES AGENCY
<br /> L)EPARTMENT OF WATER RESOURCES
<br /> WATLR WELL DRILLERS REPO IT ),w.Well h',r.-______._------ —
<br /> 01bet Well
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<br /> LOCATION O WELT. (`ieeiultluvliom); _
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<br /> _ He•dn+rl■I Well ❑
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<br /> M WELL. LOCATION SKETCH Orhir O
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<br /> (9) WELL SEAIrr
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<br /> -filing—
<br /> WELL DRILLER'S STATEMENT;
<br /> it. Thi,veu vnr drilled under Iny f,lrf.dictivn and rhir rrrx,rr h trot to rhr J"' of '"'I_ j.prh �I flnt "I*r, if lnmr'r>...-. �fi• 4nnuledprt and hchd.
<br /> Swnndu-e 1-0 <flrr well rnmt,letld. ---
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<br /> I ll l NVE4L TESTS
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<br /> .n.Irrii rn.dr.' Y" [) ho(] if y,3. h. whnm7,,,-,._ - D,tt of this rr1
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<br /> .!.,n,r•1•.a �n.de' 1'n❑ � Nd I!�P,•Mch onPy la this np'n
<br /> t:nr Ikn tatv.7•Tay IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NtiMGEAEl3 FORM
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