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}RING WF:.. LLyS7�3,L—ta;ICN RZPCE <br /> Data: / <br /> Teoa, Depn <br /> Se lg <br /> e ( om� Cto) <br /> ?-esse Addressql/ ,��.� Fate:?ad't (from) 79 (LO) <br /> 110f BSL° Lewell No.: Gd <br /> Grout (f--om) (to)Inspector: Dra ng rig type 2 i3D <br /> Anger a.D. <br /> oe^IL No. Comnleti°n- Stove pipdc^--sae box (este one) <br /> Drlling Company. 1cas'_a4 <br /> I� he_yht <br /> Dr11L-: � ---� <br /> �e i wD <br /> C°rsu!tanc •� <br /> rra�^racx <br /> Geologist /G� tr?_iCN CCMP CCN <br /> C,-Jjnl Sal=* � <br /> cr-rXt oc. V4" ry=0. Brat <br /> Do est co sewer <br /> Domer:c well on site <br /> if yes, locadon and distance - <br /> 3 <br /> .:C C <br /> O <br /> S N?L A1C = gtv.i?adc <br /> iololi.g em°erdLCSe �� �Gi��L'+� � = I <br /> Screendng Method / 'tQ <br /> Trac`_dng Sheet - 'J/ a) �-'_- <br /> S?C[LS <br /> Storage Ylerhod W <br /> CoaLaminatioa Note AJC Y/ � /1 �1' Casts, type �v <br /> / {'tom 2 is S=ee-_h�R" <br /> Storage Location '� Blank— — <br /> Slot size . 0 <br /> Bags ce=enzt <br /> GROU:LNG Buckets bentonite <br /> Bags saad/g lvel <br /> Deoh co ware-- rater?a& ypdsize <br /> yli. Rados Surae Block: - C Y <br /> I-stzlladon Me_.Od - Duc_ssed with geologic' - C Y <br /> Qu=n=y installed TYoe of=ethod <br /> o ll,4 <br />