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HHHB B^3 w«TFRh "-E NAHF OF APPBOPBIATOR F a E T 1 LOCATION OF CU1»ED WELL UfT Tom " " " COBPLITIOII US£ - " " MMH^HH W " " " «««>» NAME OF APPROPRIATOR 0ATE ^ ^ ^ ^ ^ WATER SOURCE r..p.«. r v« T,PE KCPTK ^ O«TE STATUS . ^ flB

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