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0 <br />WELL OWNER AND ADDRESS <br />' <br />4 /E <br />WELL RECORD <br />WELL LOCATION SECTION <br />LOT=- BLOCK - <br />VILLAGE OF ORONO <br />CRYSTAL SAY. MINN. <br />LERS SIGNATURE <br />DATE <br />PERMIT NUMBER <br />r •'� <br />D ING COMPANY <br />ADDRESS _ <br />T[LEPHONE <br />SIZE OF WELL __ -_-INCHES <br />WATER LEVEL <br />WELL DEPTH <br />--FEET <br />DRAW DOWN L' <br />FEET AT _--6L.9 GPM <br />CASING DEPTH. _1 if 0 <br />_FEET <br />CAPACITY GALLONS_ <br />5 <br />G'US�_PER/HR. <br />DEPTH OF IMPERVIOUS FORMATION_- __- _ _ . __FEET CASED WITH <br />SCREEN- �FEET_� Lt INCHES BY _ � .INCHES WELDED JOINT ❑ <br />MAKE AND TYPE MATERIAL:2_.. ,4c / sr SCREWED JOINT Cl <br />(OV[R) <br />SAFUNIOR SPACE AROUND CASINO S[ALED WITH: ❑ CEMENT GROUT C PUDDLED CLAY [] OTHER <br />DISINFECTANT USED-___ <br />HOURS LEFT IN WELD <br />(OVER) --- - <br />