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WELL DECOMMISSIONING PROGRAM
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Please provide the following contact information:
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| Operator Name | |
| Street Address | |
| City | |
| State/Province | |
| Zip/Postal Code | |
| Phone | |
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Date -- mm/dd/yy
Location Information:
| Section
| 1/4 Section
SW 1/4
Type of Well
| Depth of Well (in feet)
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| Diameter of Well (in inches) |
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