GW1-2021-03565_Well Construction - GW1_20210823

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w—Mrctimt.,nnlv t CTW-1 is needed. lhdiMa TOTAL.NUMBP,R of v me CanstriwAina rtrtails. You uaw alm mmb additional pages if n winry.
7 1f'eWr ive11 depth below land Snf7hc= V J 11f:1 W. C All W.M.- Submit MIS tbrm ndQfin 30 days of completion of welt
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?Ah.flee tfltiertioa VIRAL to add o n to tmading tine few 19 ft ml PM In 24A
1Z WeiT e(MatrueNnik lnethndt mfave,also submis one copy of this form+vhhin 30 gigs of completion of well
(r q male,mmrs,aihie,direct irittU,AC.i coaqtwlion to the following:
lYfR WhTCR Rt 1'17 Y Wtdi i q ONLY: Dlviston Af WAtrr 11RDetlttleA,lillderglnnnd II(jRtlOA eC'Oittr0l Pea�ram.
1636 i�ail3ervian Center iltwielo,NC 17OW1636
13A.Ylcltl(gpm) Mrt tlilul of test _ Zric.rn:Walter 3unak,&►eieetlon t e"L. in Additien tp gMding the 1hrm to
Menddrncs(cs) above also submit nnc'copy of NO fbtm aidibin 30 At"OF
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