GW1-2021-04563_Well Construction - GW1_20210429

Feb 1519 05.4313 01eaiwater Well Drilling 82M22-7241 p.1
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E+apralreAiPFor CGtAed-Lnnp Geotbat�m l Wells having klc.tMe Vora may use file tuck of this"to provide addrffmi wdl site deEeil*or well
rxtnalnlctian,ooh 1 GW-1 is pe¢dcd rndtcato TOTAL NUMBER of„r.)ls CI)tt9ttu000 drh+iis. yOLt m8y RISD eQ1 b eddirttmtd
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Farm»/apfcltslJvnlidatlrrltvifdffferarrr(e:wnple 3(n�Mtr'mrd i@lf►4) �) 2' FM AUM: Sulmlit This form Mitt»n 30 days of cAmpltsion of well
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M itonenoledlamercr• t 1417 Man surviae Ceater,M41111gb.NC3709-1617
hn+) 24b,parlL►r t♦ lertion hells: Ll 4"don to(sanding the fbao to dug addtm>,I in 7 iz Wei;cnnetrnetioa inetbod: rp-i t�� shave,Rho.1uhm"one eopy of this form witbn 30 480 of aplidmt of well
mtnry cable,dirar<t Intsll,ctc.l oaxorutdton to the fol loArint
l OR WATT R Wppl V W$tjq IDNLV- Division ofWater Rrmtumt&Underground in faction CpA"pr%rnnh
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r636 MANServloe Ceara,RA1100,NC396r19-t636 Jrl Yirld Iflplmj �^Methiut of test
ti!c lror 4e Cnteai►&to +-O a toe- fa uddMan to sanding 11tc fbtm to
nisinFee"on IYPC Amatmk the nddfoc $) "bore, also submit one copy of lhi3 font, wtgNn 30 days of
a>mpietion of%'Fc" comuucdm to the corailty health department of the county
VI}rorE cona,Rlr2ld.
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North OUMIfnn Dapnrtlnont of Itn.•Irdnma ntal Q11ah1g-AiYislratr of Warcr Rayarge�
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