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i <br />5 <br />-2- <br /> <br /> <br />Hole No. <br /> <br />Township <br /> <br />Range <br /> <br />Section <br />Quarter <br />Section <br /> <br />Elevation Hole <br />Depth <br />(Feet) Hole <br />Diameter <br />(Inches) Type of <br />Cement/ <br />Sealant <br />DE-LW-33 T5N R91 W 3 SW 7049.144 1093 3 Y. plug Gel <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />Method of Drilling <br />Amount and Volume of Intervals where Water (Core, Auger, Water, <br />Hole No. Cement or Sealant was Encountered Foam, etc.) <br />O~LW-33 72 bags Bentonite Chips <br />10 bags hole plug <br />2 bags cement <br />~~ ~~ <br />Sign lure of uthorized~ epresentative <br />Ex~fo{^a~in>t~ l~iGc~ol~P~ <br />Title <br />~ ~c~ ~~~; 7or~ ~ <br />Date <br />