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<br />-a- <br />Hole Hole <br />Hole Quarter Depth Diameter Type of Cement or <br />No. Townshi Ran a Section Section Ft. In. Sealant <br />c~•s <br />GW°s <br />Gk)•s <br />c,~•Sa <br />~s,~ <br />3 <br />37 <br />3Sw tJ i 5 ~ S •v e~J~K; ~e el e <br />37w~ BlW l E 36-V <br />7w~~ ~~ w ~ E '7 7-0 <br />~~,o ~ w 6 w 3~.i a <br />.i3 ~ ~ w sw .v ~ <br /> <br /> <br /> <br /> <br /> <br /> 3 <br />w <br />~ <br />Method of Drilling <br />Hale Amount and Volume of Intervals Where Water (core, auger, water <br />No. Cement or Sealant was Encountered (~Pe~l foam, etc.) <br />~w~ 3 c1~4v <br />7w~ ~ ~ a <br />w~ ~ ~/ a s 3 <br /> A <br />3 3/ 4 v ~/ <br /> <br /> <br /> <br /> <br /> <br /> <br />Signature of Authorized Representative <br />~ ~ ~~~.; ~~G ,._s d 1 <br />l Z- 6 `l ~ <br />Date <br />ds <br />T;tvk <br />(Rev. 5/83) <br />Doc. No. 3078 <br />