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:-~ <br />,' <br />-2- <br />G <br />Signature of Authorized Representative <br />Geologist <br />Title <br />(Rev. 5/83) <br />Doc. No. 3078 <br />Seotember 26. 1988 <br />Date <br />Hole Hole <br />Hole Quarter Oepth Diameter Type of Cement or <br />Method of Drilling <br />Hole Amount and Volume of Intervals Where Water (core, auger, water <br />