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-W3Schools.com

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- Date Completed: -

Insert date completed here

- - Permit Number: -

Insert Permit Number here

- - State Well Number: -

Insert well number here

- Signature -

Name of the person here

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- Owner -

University of Connecticut

- Location -

Mansfield CT

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- Date of Report: -

Insert that here

- - Registrant Number: -

Insert that here

- Other number: -

Insert that here:

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-Location Relative To Landmarks -

Insert description here

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- Use : -

where to use

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- Drilling Equipment: -

Write what equipment was used

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Casing details

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Length: insert length here

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Diameter: insert here

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Weight per foot: insert here

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Drive Shoe: insert here

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Threaded: insert here

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Was Casing Grouted: insert here

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Yeild Test

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Methods: insert here

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Duration: insert here

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Yield: insert here

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-Write down the yeild here with same format as above -

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Water Level

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From Land to Surface: insert here

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During Yeild Test: insert here

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Depth of Completed Well: insert here

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Screen Details

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Make: insert here

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Length Open To Aquilfier: insert here

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Slot Size: insert here

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Diameter: insert here

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Gravel: insert here

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Diameter Including Gravel Pack: insert here

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Gravel Size: insert here

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Gravel Pack Location: insert here

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Depth from land to surface

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We must find a way to iterate based on the value in the submit form

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Owner Info

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Well location

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Casing Details

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Yield Test

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Water Level

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Screen Details

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Other Notes

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Well Name

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short well description

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