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.. ~__. .. _ .... ..e. s..~.. zs a'..-.. <br />F E PA - WPSNmGTON, DC :Ds60 <br />PLUGGING RECORD ~ <br />,EfNO PODRE SS OF FEF MITTEE I w.uf •wp sG:P(55 DI uENLnQ CCa..rawr <br />-- <br />.OC:TE WELT:-NO OUtUNE UNI7 ON <br />iECT10N P'?i - 6s0 PCaES <br /> <br />N <br />I I I I I I I <br />I I I 1 I I <br /> <br />I I I I I I I <br />I I I I I I I <br />I 1 1 1 t r <br /> <br />I I I I I I <br />+ <br />I I <br />I I I + I I I <br />I I I I I I I <br />I I r <br />I I I I I I I <br />I I I I I I I <br />5 STPTE i CGJNTY I -EFMrt nurse EF <br /> <br /> <br />SUFFPCE :OC?F70N CFSCFI-iION <br />'. OF 'P OF ', SEC'ION TG~`/N!NI- pPNGE <br />IGCSTE WELL IN rWG WFE CTIC NS %~Cm NV PEST LINES Of GUP P7EF SECTION PNO ORIE'JNG UNIT <br /> <br />Eunatt <br />locauon ~. h. Item IH/51 ~ 4n• al cuaner seglon <br />tine _ R. hcm IF ^fn _ tine or cuanrr aeevon ' <br />~ nee i a.u,l u. r.w. ..n.aa wr rl°u °n baaa° <br />TYP_ OF PUTNORIZ.ATION p„`°, mt,aa , ,~ ,a„a„a~na la lap u. ael• <br /> <br />O Intlivitlual Permit <br />Of,na Fermn <br />^ Ruq. <br />Numper pf Wtlls __ <br /> <br /> <br /> <br />ease Name <br />Cr'IS7NG AND TUEINO RECLPD w-TEA PtuGG:NG I WELL PCTNnT <br /> <br />C C'.,e551 <br />rrRCO ea E4ry,4NEN( C. CWEM ryr,, <br />E] TNr buw 4.pb/ <br />¢e l VJTIL°/Fil ITO EE ?IT IN wFLL.P'n ltG lE'~ In wEL lml NOL5512E ::PS!n <br />- <br />nn. powaa <br />` CIT. Oumt aaN°. 4wny <br /> <br />I I I <br />I I i <br />G wnan<w Paa.°rv a T. ,_.r,w 4gert <br /> <br />C <br /> <br />I I I <br />I I c 1~.°...re°n s.4.t. <br />cuss m ouu. <br />I I I I I <br />I I I I <br />CE!PEFrmNG 70 -t'JG PND •eP NDON Oa TA: i -(yG n I r(uG n ! P(uG a~ I rwG Pe I r_uc +s i r:uc +a I F'tvG ar I <br />e, I,p,t p, rapt ,,,,..,K„ rmt wu et rl,°te fincnetl I ~ I I I I I I I <br />>, ,e eonem el Te,emq er Dr;u -:o. m.i I I I I I I I I <br />el t.mtea re e. uaa r..cn uum I' I I I I ( I <br />n Vo,um• re e• -ump.o au. R.1 I I I I I I I I <br />umre Toe er -lut m.l I I I I I I I I <br />yvrre Tao of -lue lil IaCS°° RI I I I I I I I ( <br />,. vee lu~wl.l I i I I I I I I <br />e.m.m or o,rer w,.n.ra6r» nn I I i I I I I I <br />U5T PEL O-!N r.Olf fNOiOp PEAPOAP rED INTFpNPES <br />Pram I Ta I Pcem I Te I <br />I i i <br />I I I <br />I I I I <br />I I I' ( <br />I I I I <br />vcurt or Cpatnur pr Pu Nerla tt 0.epresentat(vt <br />I SiSPS tuft pf EDA Ftpresmpttrt <br />CERTiFiCATION <br />I certify under penalty of law that finis document and all attzc~unents were prepared under my <br />direction or supervision in acccrcance a.i th a system desicned to assure inat dualSfieo person- <br />nel DrnDeriy catr+er and evaluate the information Suomi t:ec. Based on my inaui ry of Che Derson <br />or Dersons wnp mxnaoe Ne system, or inose Dersons directly responsible for gathering tT(e <br />information. the information sutrnitzed is, to the best of my knoti.ledoe and belief, trve, <br />accurate, and cDmplete. I~am aware that there are significant penalties far sutmitUng false <br />information, including the possibility of fine~and ~imprinscTrnent for thawing violations. <br />(AEF. <D [FA 722.22) <br />'. •NO OFFIC:PL TTrC=/Itru. qD. r-ner/ I STGN.,7LAE ~ I OPiF SIGNEC <br />