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WA <br />Hole No <br />Township <br />Range <br />Section <br />Quarter <br />Section <br />Elevation <br />Hole <br />Depth <br />(Feet) <br />Hole <br />Diameter <br />(Inches) <br />Type of <br />Cement/ <br />Sealant <br />Refer to Attachmen <br />Refer to Attachmentl <br />Refer to Attachment <br />Refer to Attachment <br />Refer to Attachment <br />Refer to Attachmen <br />Refer to Attachmen <br />Refer to Attachmen <br />Hole No. <br />Amount and Volume of <br />Cement or Sealant <br />Intervals where Water <br />was Encountered <br />Method of Drilling <br />(Core, Auger, Water, <br />Foam, etc.) <br />Refer to Attachment <br />Refer to Attachment <br />Refer to Attachment <br />Refer to Attachment <br />Signature of Authorized Representative <br />Title <br />Date <br />8/93 <br />