GW1-2022-06468_Well Construction - GW1_20220519

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1i.tlgoehaledlameter; S1---(in•} abovo,Alen Submit one eopy0?OlN form within 30 tiny.of coIDFlatkm of Wdl
12,Well conetnietlan mtithod: I C� r— ----�-�, atatlsmatton to the fallOwinM
(i r..auger,wtuy.cok,plr4ettnrth,qmj DIV1lIan orWstar 1(itelnttm6k tjndatigtroul111 in�ixtlOn Control"ram,
- Im mail3ervioe{tartar,AtidaigM.MC 27094636
I?OXt WA' i8L,PPi.V WE1,1414 ONLY:
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1st.YiatA(Ri►stit --.i ethod of lest._ 1 -—- - the nddtcss(ca} abtiva also Submit nna copy Of this fotln within 30 rltlws nt
�rnamt;_____ ontnplmion of�'Vdl crmstsrrceion•aa the county health IMPaOMt of the county
1.4b,01.0"recloon type; ..,,-. anmre connrrnated.
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