GW1-2022-06015_Well Construction - GW1_20220621

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L WELL CONSIRDCTION RECORD
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a a WELL CONTRACTORCERTHgCATION#_ a6 '/3— ZZ'
1.WELL CONTRACTOR:
rL TOP OF CASING IS--Fr.Abner Land Su ben*
*TOPaf� atmbelowlardsufceamyrequffe
wen (trtdfiuidua� avarianceinacoordarmw1h15AN=2C.011&
_f `��i L.1��� �'t3 �n e.YIELD(gpn):�SHOD OF TE$T
Well Conb'actur CbuWW Name E DtSWFE=ON.-Typ® Amomd
SiREETADDRESS ak 3 fs 70--u-z l �E'� g- WATIERZONES(&q M):
J1 L a 7 avL7 From To F=L To
q-ly Taxm state Zp Code From To V1 17 FrotL—To
i 36).: VJL7— 5(yab To Fmm To
Area code- Phone number 7. CASNG: Depth DTiftmMmiewit Mrl
2 MLINFORNATION:
SITE WELL IDOff- Fmn TO_Z&_FL
WELL CONSTRUCTION PERMnnW 1-,,VV 2I&3-Go FKml __ To,_Ft
OTHER ASSOCIAT®P2Mff g e) From Tc Ft
3.WELL USE 9%e*Appkabte&kX) a l MfiCWM eb�irjj IL GROUT.6 Depth MaUmd
Ws OM 08ma (ustuse 3 fl 6ram�To Ft
Frorr�_To Ft n�
DATE DRUM /9 7 7 From To FL -
TWCOWLETED Aim Pma a.WELL LOCATION: 9. SCREEN: Depth Datameter StotSite Malarial,�
Cr l COUNTY D K.'n �i1 �o�--To Ft ur. In-
From To� in. in_
O a Flom To FL in- in.
(S W Ham Mumem Cairy a .s b&gftL tot Hio.,p&WL ZpCD&)
TOPOGRAPHIC l LAND SETrM 10.SANDMRAVEL PACK
O Shre D Vaft U Flat ArMdW 0 Other Depth St m Material
(dm*app°pdd*b" Enom To
LATT Wr= vdmfts sccoffift Frmn To FL
LONGMME.g) C. M� madeenna coma Rust To FL
Latitude/longrtude sotn+ GPS A TqMgW 11.DRILLING LOG
bir»mp From TO sns�Sft°�a»d r e s �.•y�� �Pr Fo sm*ir°es«'ptr°rt
5-FACILM rsmanamaalmab*mft lteiaMUM isr=M&
FACIUTYMgpappT�� -
NAME OF FACHM
STRIMTADDRESS
CftyorTown Staw ZP Code
CONTACT PERSOHI
MAIUNGADDRESS__oZ7�Z� /'LLf�K /�'/X t,r;_ :;rr�=;s�tt�,�re•�i=�-'Y"'�:��F�`•' r
CiW a l wn- - statezip Cc" i ( /J
(,?,31} 7 a 7' © �i/ t
ArBa code- Phone lumber u
S.WILL DEiAII.S� IOOrEREBYCEUIFYTIWTMVVU.LWASCO SnU)MMINACCOFMMMWRH
a. r ISNNCAC2CL WB.L�4rANDAFMAEDTHATA,CWYQFTM
TOTAL DEPTH: �-7 RECORD TO -WE LOWNERL
b.DOES WELL REPLACE©ISMM WELL? YESU NOD � - -� .7—9
c.WATER LEVEL Below Top of Cas-arg: g� , F7: SIGNATURFOF IFIED,WELL CONTRACTOR DATE
(Nse+'ifAbare Tcp of Cmirlg) Al? .
PR UPPERSON CONSMIJUNGTHE WELL
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Stubmit the Oi fM VW DiY=Ion of WafAr Qltay t 30 dtsaM At1n:bdbm=& t A1jR,
1617 MM Service CWW—Rt dq%HC 2FW9-161T Phone No.(mg)733.7016 eat a& Fam SM-lb
Rev.12M7