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<br /> <br />-2- <br />Hole Hole <br />Hole Quarter Depth Diameter Type of Cement or <br />No. Townshi Ran a Section Section Ft. In. Sealant <br />~•s <br />~W~~s <br />~~.~•s <br />c~•sa <br />~'SA <br />3 <br />3-~ <br />35i.o lJ I S ~ S -v e~,d~~ i ie e~ e <br />37w~ glw ~ E 36-v <br />7~~ ~~~ ~ E -77.0 <br />,:~,a ~~w b w 3~.~ a <br />.13 v ~ w Sw v ~ <br /> <br /> <br /> <br /> <br /> <br /> 3 <br />~ <br />x <br />Method of Drilling <br />Hole Pmount and Volume of Intervals Where Water (core, auger, water <br />No. Cement or Sealant was Encountered (~cc~al foam, etc.) <br />5~~ od4~ <br />7wc. - '~ a <br />1..KU ~~ a 5 - 3 <br />/~ 4 <br />3 3I ~4 V ~/ <br /> <br /> <br /> <br /> <br /> <br /> <br />Signature of AuJ!horized Representative <br />~~:~~~~ ~~ ~_z d 1 <br />l Z 6 `l ~ <br />Date <br />ds <br />(Rev. 5/83) <br />Doc. No. 3078 <br />