GW1-2021-03710_Well Construction - GW1_20210823

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■-..eNen We11a: Lt Addition to a nMoB ttra lbnat tti
(ioJ �ovc,also submit one copy Of this form within 30 days Of epinpitdlrnt Orwell
1i.11orehotediRmeter: ______f-- r' �r
wu>atcnctinn to the fo(inwire.
I2.Well coultmetltm method: eetlon Calling Plro�ratn,
(+ m,gc,Mtn,rabk,duct push,ctc,1 Ulvision Of Watcr Reemttro %Undeiglmand T tj
If Mail Servlae Ceatar,Ratelo.MC 27bh4-Y®6
FOR WATER SLM V VVf6VLS ONLY: ,
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13A.Vivid(Rpm) MCChOrI of test: — the adtityss(cs) abatrq also snbmitl one ropy of this form wititln 30 days of
comptation of mdl conSUnaron to tl:e comity bcalth deparmtait of tltc county
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