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R N <br /> 01 <br /> G OU D WATER SAMPLING AND <br /> ANALYSIS REQUEST <br /> U0irk 16"1*6*N PROJECT NAME PROJECT N0. <br /> DATE SUBMITTED PM/GEOLOGIST <br /> cn SPECIAL INSTRUCTIONS / CONSIDERATIONS (well access, time from*) <br /> •ssocierEs <br /> WELL LOCK <br /> NUMBER <br /> ❑ CHECK BOX TO AUTHORIZE DATA ENTRY <br /> WELL NO. CASING CASINGDEPTH <br /> OR SOURCE DIAMETER LENGTH TOWATER ANALYSES REQUESTED . <br /> NOTE IT IS VERY IMPORTANT TO INCLUDE A COPY OF PROJECT PROPOSAL <br /> AND A WELL LOCATION MAP OR SKETCH WITH THIS REQUEST. <br /> Figure A-3 <br />