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WELL OWNER AND ADDRESS <br />WELL LOCATION SECTION <br />*ios':T ^oM. <br />DRILLER S SIGNATURE <br />DRILLING COMRANV <br />LOT BLOCK <br />DATE <br />WELL RECORD <br />VILLAGE OF ORONO <br />CRYSTAL BAY. MINN. <br />PERMIT number <br />ADDRESS TELEPHONE <br />SIZE OF WELL_______^ INCHES WATPR 1 PVPI 7 ^ mmmr <br />WELL DEPTH / ^ ST »»FT DRAW DOWN ^ FEET AT O AMNI <br />j CASING DEPTH- /CAPACITY fiALLONG / ^ 0 MPB/UM <br />DEPTH OF IMPERVIOUS FORMATION / O rPPT <br />j •CREEN ---------^-----FEET ^ INCHES/BY 2. INCHES <br />] MAKE AND TYPE MATERIAL: fj . ^ <br />REMARKS.------------------------------------------------------------------------------------------------------------------------------------------------- <br />CASED WITH <br />WELDED JOINT □ <br />SCREWED JOINT <br />(OVER) <br />KINO OF FORMATION COLOR <br />STARTED <br />DEPTH 11TNICRNKSS <br />OF <br />FORMATION <br />tUu-O Vo'^^o• <br />V p '/oo'^0'77^- ^/o&US"JS'JZi X, .i^r'/O' <br />• <br />EXTERIOR SPACE AROUND CASING SEALED WITH: Q CEMENT GROUT Q PUDDLED CLAY Q OTHER <br />DISINFECTANT USED ______________________________________________________________________________________ <br />HOURS LEFT IN WELL <br />(OVER)