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GW1-2021-00382_Well Construction - GW1_20211228
r -- llL:�w]��V1TAL WELL CONSrR�1CTION RFC - _• Na&CmoTmaDgaatmmtofF milut AResamoe9-DWisionofWdwQua&Y WBLL CONTBACrOR CERTIFICATION# �-lp t/A- 1.WEiL CONTRACTOR: d. T+oP oFCASWG IS__4 —.FT Above told 9afaoe< 'rapofam"Mumbdledow belniw Ww=vfaoe may Well COmbacWr(kt0d*mQ WWw } ,C.o e.YIELD(Wm):_2_. -6 0FTT /r A AY 7n, is. � 4 L)G I ©. ��►G. D P i DD.�Pe 61 fN AMOM* oZ-L 61L wfe8 Contractor Name I �� sTREETADOREss a wAT>Ctt29�Est�+): F. - O To 7,5 From To n L -7- a •- font 3 9 to To ,q 7 FiMR--To (Sty Town State zio Code From To Flom To _ I/2.7- I/y7-j 7 caSMG: MOM oimneW mom+ Material L WELL DWOROATION. r. -Q—To SYiEYYELLlDft8P0cdA4A f�IL'paDlz- OIS �" To Ft, va LL coNSiRUGTION PEFMMWa, - Fm__,To Ft` 0MiERASSOCIA•IMPEFOffB(ffapFft b9) . L GROUT: DOM M MaV►ad &WELL USE Pie*ApAcohb W 0 Mun �Du�'GdC ReoerA From�_To�Ft �2�• _ __ Irrvorp Omer (la use ov j O w.c s it c, Ffom To i s DA E DRLLED I I- I From To FL TMCOWLETED J. :D'o AND PNg a. Sf� DeFM STetSixe Malaial 4.MI.LOCATION: From Toj7W - -. �- �- CITV 4-h. OOUIYTY ;� pa Frown ToFL �- _ yb D R�p c.r Cr c e K Q/,{� 7 ba2Z- From To FL Iir. �- (5hed Ne�ne.[�Obe�s.0awaar+aly. Ltt N0.P�ioeL Z�Code) t0.SANDMMVEL PACK: TOPOGRAPHIC/LAND SETTING: 069& Sim Maw Q Sime 0 ValeY 0 Fiat A Ridge D Omet_ r-mm To (dA*aPP 091 LATITUDE �� _1— 'j o Ft. LONGiR1DE �. © In adximal fbmmt Latitudeilongimde sour=)K GPS 0 Topographic map IIMRiLLM LOG � Fomation Descdp*n Fmn TO (bwSorr orwe8 mustbe shorwr arr a USGS fpo mW and aH3~lob sJbrmffaotusFn9.C+PS) _ y rw.,' e- " a.t. hoc. 7 5' 5 S.FACit]7Y-61Deneuisoftieb�C7dle1lQ19neiiSlorab0. 2�'y,LS bh : C FACILRYMAP On amp DAME OF FACMY S'tRiD:TADDRESS CDy►orTown Stdo - zips CONTACT PER.SO" I (L±-� h Ga f �ie �' SI►1#!'1 teu_ MAWNG ADDREss l y S!o ,g e-4 k a-, /L .SwIn►o rfi-41d YIG .273.5-ar .1L COyarTown State To Co (.I& )- .2.3Y- 57 S Area code- Pbm number S.WEI.LDE AILS: t [oDtaaaEWcer WVMWT asweuLwasCONMI cr®araDooFMAN VMH S UANDAC2MwaL.00n sr �r awWACGP+WTM a.TOTAL.DB4M asoorm IL DOES WELL REPLACE EXM—;WELL? YESO NORf c.WATER LEVEL Below Top of Caing L FT '� wa l-COHrRAcroR DATE st (Use'+'ffAbaw Top of Ca" k PERSON CONSTRUCTMTHE W9.L Submfttlw fM10 dtDtb*DivkionofWabrQuaftvdBM30day& AlftckdbmwftnMW6 Form(WiF-lb 161T no Servke Center-ROM AM,NO 27409-1617 Phate No.("9)T33'M6 Gld S$L Rav:121D7