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WELL OWNER AND ADDRESS <br />WELL ION TION p <br />V. <br />20, <br />LLER'S SIGNATURE <br />l<<c WELL RECORD <br />BLOC VILLAGE OF ORONO <br />CRYSTAL BAY. MINN. <br />GATE PERMIT NUMMER <br />DRILLING COMPANY ADDRESS <br />TELEPHONE <br />S~ <br />SIZE OF WELL `� INCHES <br />WELL C _ _FEET <br />CASING DEPTH -- , �� C1 <br />—FEET <br />WATER LEVEL 12 FRET <br />DRAW DOWN _.FEET AT�_GPM <br />CAPACITY GALLONS —I--• � Cam—PER/HR. <br />DEPTH OF IMPERVIOUS FORMATION—_ FEET CASED WITH <br />SCREENFEE <br />T �' WELDED JOINT) <br />INCHES/oY INCHES <br />MAKE AND TYPE MATERIAL: ,, SCREWED JOINT ❑ <br />REMARKS: L ��"'" <br />(OVER) <br />KIND OF FORMATION <br />COLOR <br />STARTED <br />DEPTH <br />ENDED <br />DEPTH <br />THICKNESS <br />OF <br />FORMATION <br />REMARKS <br />. Z/_ <br />_SS <br />I <br />EXTERIOR SPACE AR,JUND CASING SEALED WITH: CEMENT GROUT FUDDLED CLAY D OTHER <br />DISINFECTANT USED V <br />HOURS LEFT IN WELD <br />(OVER) <br />