GW1-2021-04105_Well Construction - GW1_20210823

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8-For Geoprobdt{pf or Cl(=d.i amp Geothermal Welia liming thcsantr 11nu may usa ilia tack or then page to proWde addlionul vAl site dt'tsils or well
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`t 7lotat well dCPM ilGfoW land Sutlttcc: V 103, IFOr AI! Willis: SUbMit Otis form within 30 days of complction or wall
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iZ Weti eonstraetltm nwilbod; r u 1 l,X '&nVe,abo submit one copy Of thka farm wilbin 30 days Of wmp11011CM of Wall
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the wMmss(cs) above, also subunit osc 'copy of this form viddiln 30 days or
t3A.Diainfectkrrt type. Ammar- o7mptation of.vdl constaaction Ao Lhe coney health department of the county
wham coonttacted•
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