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DEC-16-99 THU 9 :39 Lll_rh1 STODOLA r v WELL CO. E,1 293801 54 F'. 02 <br /> WELL NOTIFICATION -WELL NOTIFICATION IS VALID FOR 18 MONTHS. 639142 <br /> Send notilicatfon form and payment (check, money order, or teadit card Information) to: MinneSola Unique Well NO. <br /> aUnnesota oepRnmrnrorNae++h,wetl M,.r,■gerrra»l 6xrfon,P.O.8or6d975.Sr.Paul,MlnneFafa 55164•OilfS. ' Credit Gaid Type: 1-7 Visa C1 Maetercaird Exp.Dale .— <br /> ATTR:CASHIER I l <br /> F.empt Iran paylna fee ❑Yes - Print Cardholder Name <br /> an walp,,r Supply W ll l:rrdil Gard Number — <br /> h..<;kwclllype dleFamiiy!Olnnr_. —_ .--- ( . <br /> nmmuniL FWc(4924) Autharlced�ignA.ture. <br /> ❑RemedVel(4;125) ❑Cxnmunily PWS pa 622) p NGnc. y. _ <br /> Ll Dewaleriny Well(a) Total number of dewaloring wells _ 2ir/Well-1 to 4 wells(4873) D$8OO!6i19-5 or more wstl!�(4861) I <br /> C.>.my 70i'+ru�pp Nyrcp Tmwn:hip NG Rnn9�DN 9mrtlmn v. F•."iM <br /> Hetzrl.eU`in oron4 117 23 08 +• <br /> WELL CITY a :r4a zipdo fr.r+„mtar <br /> LOCATION well L4:iii.: A1,11.11114 <br /> pryYrim Yclophje.0 NJRWar <br /> w.n owner Wr",.(t'rmq <br /> Erotas BuildinR Cor ' ) <br /> Sl�ie ZiD Cola <br /> . CIIY <br /> WELL wl a ow%r Sired AtJ&tls <br /> OWNER Cele <br /> wn Uwn.r ilY'"I�r <br /> poli)) F r,'iii� L679n[.m lin. <br /> WELL Will ccnUmClor( -- Ge . .�Q 2 717 2 <br /> CONTRACTOR Don S'Codola WE11 Dril 2-16- 9 <br /> F■livre It prevlee Proper notification and fee prior 18 tea ppinnlnq of well construction is a vldallon of Wrinesolia 5 Lea,Chapter 1891, )nay result In IM a■■�ermnl o}en edmintakellve penally. <br /> WELL SEALING NOTIFICATION-WELL SEALING NOTIFICATION IS VALID FOR 18 MONTHS MinneGala unique Walt Nn Ur W-serla5 No <br /> (ingvtt mora.a not MII11lea01d Well and Boring S9allny Ho. <br /> knawi�) <br /> Send notification form and payment(check,money order,or credit card Information)to: - — <br /> Minnesota Department of Heahh.well Management Section,P.O.Box 64975,SL Paul,Minnea6la 55164.0475. C _ �H V <br /> 3 16 <br /> ATTIV:CA9)41ER Well Management Section Fax Number:(651)215-0978 Credit Gard Tyle.: D Visa O Mastercard Eup.Date <br /> x ni lhorn -a In fee OYe.. a - _ Print Cardholder Name R;'.1LChard A■ StOdola <br /> Ee pY B - --' — <br /> ^ Well Sealing Notit. .gtipn <br /> Ghdr:k W li lypa: credit Gard Nuniht.< — <br /> at6r'SUpI?ly Wt311' U Morillitring V ell ❑Olhor butliorizetl Signature - -- -' <br /> _ <br /> County - -- Township Namti Township No. Range No. Section NO Y Fracliori(%Mr -Ig.) <br /> WELL Ier)nepin __�Orono 117 _ 2 ��$_ tfs "" 114 <br /> LOCATION Wall Location Addrrr5t City Stale Zi' Code Firo Nurrd:wr EsI Deplh Casing Diarrietar <br /> 905 Tonkawa Rd Orono ` _ �' V �,. . <br /> Weil Owner Name(Prim) Daytime Tuirphone Num bet <br /> WELL 1fJell Owner 51rea1 Address Gilt' �taie Zip Coda' <br /> OWNER 3436 40th St,. NE 8,Lrf o o-. . ' 55313 <br /> Well Owner Signature Dale <br /> WELL —~ -- Liconsed or Raglalered Cont,;x lot (Print) G r r F Dal9, Llr.pr Reg No. <br /> CONTRACTOR DonStodolaStodola Well Drill n 2-1G�9 27172 <br /> F&➢;n'e 10 provide proper Identlllcation and five privy 1,the beglnning or well aealin is a on of inn a Statutes,Chapirar 1031.and may ffi8ult In the'e5sessnien1 of an <br /> admini-Wative penally,Noli iration is not roqulreA t0."sl a boring. .-. <br /> ' 1 <br /> 4 <br /> 1 <br /> 1 <br /> 1 <br /> A. <br />