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HomeMy WebLinkAboutGW1-2021-05186_Well Construction - GW1_20210527 r' _-_ RESID��JNTIAL WELL CONSlRDC l RF.00RD �- Nw&CaorwADaputmartofEnvuamemt imdNeanal PAsoumes-DivWm of W'dcrQnalitY WU&CONTRACrl0R CERTIFICATION# 1.WELL CONTRACTOR: d.TW OF CASfMS W __FT.Abase LardSWbW - a h w �� `i!; -Sin ;f�► a vvaftm in o p m b nos ath 1 MCAC wea C0116aC6of t e.YIELD(OM):�-SOD OFTEST i r D L• r- l CO. .�ne. D�iFET:TT010 Type anramt c w�5 Wall Color Mame sTREET ADDREss �!a 3tt n tc t] /�' a WATER DIES cdepth): Flom J1 n To /lo l FAA_-To ma-!jJ cc.. nL o'Z?0 .7 ftm /&D To 44 R=lt—To Cft TOM State Code Form To Flom--To AMR eode-Phone number z Cas�t� Depth Dimmeler rn.a 2WELL88'ORMATI Fes_—To L FL L18 SLIC l�/Q SITE WELL ID#(ifaMirml e - Fran To Ft_ WELL CONSTRUCTION P M6�eLE d D -•-/S Fran To Ft 0THERAS90CIAT®PEFWlT9(EapP ) L GROUT-6 08Plh Meuffm Method S.WELL IMW Pm*Ap0cd*eon MM-W U "*kG Q n hAl _ Or lce� PUI< 1040010 OtherO Ps use) rn e s i' _ F o R G ' DATE DRILLED FoM—To FL TUIECOMPLETED AMO PNO 8. Sty Dew olamdw Stage Material 4.WELL LOCATION: l� To Fter- in Cffr !a 0 n e ✓ // OOUN7Y From To FL in m. c1'1�A � L/a ?� l��'ue✓ • Sfer►� //e a-1 y8 From To Ft �. ft (Oft Name.Mo ms.COMMUM.SUMMMM Lot No,.P2M Z000" IL SANDMRAVEL PACK: TOPOGRAPNO 1 LAND SETIM: 080sba malem SMw D(drodcapp�opfiare bmQ Mqbcin 0 01116r Ei?nl—_To LATITUDE 1�(9 t �- ra,szoarfpgr�s or t'r0lm T FT. LONGTTUDE�Q_y° sq, 5)- # madedmalfamat sounder ji"CPS 0 TopWWbie amp 11.DRtL1Rl6 Ltd &csoon ofwe8 mustbe ooem on a USGS fto imp andFqxn Fran To Formation Desatptimr aitared 8ris form jTndusing GPS) �_ c -r t d l0 _S�3 2_ .S e l I y$ b.FACtIliY-bmemmsarmeb�atmo.trmaeraeat�lea� - f e d / .L FACILITY ID apf able d2 4 - NAME OF FACMY STREETADDRESS �'Y,.3 v �r CRyorTown State ZPcaft - — fjY 9. CONTACT PERSON Lae, se-�i rya �$ l2�• _F,. � , �rocess;r� QP/ r MMMG C9reen < ba -f) AC• 3 tiD�/y 1Zl�AW61~ Cibl orTorm State 3L Ili- ys/- 77S�z Anew code- Phone nufff" 6.IAIB!DEiAtLS: rooreaWCEff FlrIWUMWRLW SeoraTr�ucrEosrncoaauae�wmi �/ IMNCAC= Comm{ICr(pNSTpNQANOS�g1wlwTAGwWoFTM a TOTAL DEPTH:-- l oZ s rmnotm Pr OMEDTO rrE awrrm ' b. DOES WELL REPLACE EASTM WELL? YEW NOV _ J/ '� R WATER IMEL Belna�Top of Casir6 'J D Fr. SiG�IA OF CONTRACTOR 7E (Use'+lfAbMTopafCwW PRKrED NAME OF PERSON CON57RUC'TNG im WELL Sty!uw n jo-mltDGwojvWmofVlSftQuMftWlddi 30 d V& Aftc kdbr ra9on RVGL, FormOW-lb 1617 NO Senriee Lamer-Rddak HC 2YU94617 Plane No.(919)T38-M6 mrt S$L' RIM12W