GW1-2021-03727_Well Construction - GW1_20210823

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ent AAAMR,City,Rnd Zip
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6.la(are)the well(A)op mattant or CiTcmpornry ar reof(knti'iedwdlCattastamr Rntc
1,tj,stltRialj rplx'•ihrgr,!hntnrrtcmjy ftz rim twdird twu fxmq I•arAMAwd to nemlrZt,"Ce
%•In this of Trpalr to sA CXiRfitlg mil: 13Xe3 or No with jm.w,-rr'021:.Qtllo or mA JVC.AC Mr.02n&Well Cwtsi flnrr tYnryrrhrrAo Purl ohm a
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r.;arir rnrrlir A)1 na/plrys�e Vitae/lqn rrrntttlM hard of lhix level. 23.$ft dmqnm or adAill welt Ut
R.For Gtoprnhe/11PT or QoRed-lump Geolkorttlttl Wells having Me sonic 11au may use the back of ft pop to provide add lItowl well tulle doWls tw wail
'xNnRmlctinn,onlyI G%L I is nerd¢d. 1'tldicata TOTAL NUMBER or+vruc roastrMAiao ReMaits. You ltt8y alas OMb addidm►et pag>rc{FntxstMary.
driNud:___,
T1 tal well depth Imlowienti sutihec: V pR) 2,00.ft-.ill W_rl_!r: 3ullnfit tllte fafit w1fl in 30 tfigra of a mpkilon of well
Marnnllnptr.wells lilt M14eprkrifdAftant Pon011tltiiantothe follwft.,
I R.Statir,water tevrt betatr top of rAsittgr (R.) Dlvieton of Water Rtaamrrea,laformatlan Preece Unit.
l(nvrhtrhnrdlarlMrorta.rlrlg,Ill^•; Q 16117 Mal 9turvi¢eCeateh M ldg NC17W1617
1 i_Rarchote dittmetcr, ' U (in.) ?.AA Fw_1M1=flon-wepF in addition to Mdit ft form 14 ft tf WRO in TAa
itil obo submit ono aopy of this form tvilhin 30 41 of t ampietlmt of well
IX Welt coriatruagan[rtt thud; cwms tnclion to the following:
ti a.nugr,rnitlty,Mole,ditztx ptttlt,"Ca
lY>t!WATIs`R St;P17 4 WTI t 4 ONLY: DIVUlon of Water RReutn'ors.UndCigrotmd iti(ectlon CallPrrmnin.
1636 MAR sa wleie Connor,PRIO 414C 7.7096106
13n.Yield(gym)_ /Z Medial of test Me For WART gut nit&INMRAIl WNts: in addition to sanding the Rum to
tits addws(cs) above, also submit one Dopy of ft Than ltlilhht 30 days of
t.9h.nr,tnrecnoa eypa:, __ _ aomptatlort of w4l wouaaioo w the e
,�atnlmt: 1 Quoit}1080h dcilanrirralt 0f the alum).
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