GW1-2022-07296_Well Construction - GW1_20220805

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9.Tota1 weR depth below lead soifaae:-- 00 2�.RaP U Wells: Submit:this foist within 30 days of completion of well
ForinW Aweltsataadeptluifd�uitl"mpfe-30200-msd2@1005 cansfntct4oaioffiBfollowing:
1r level below tnpofcasig
Jjuzfe eval Isabove esing. Z� ( j DiVWOnofWaterBeMUMMtLonationPmeam Uxdt,
1G17Ii2allService Ceuterr$alefgLtNC�'Y699-16i7
11.13oreltole diemebet: r.�� _ (fa.) 24b.Byr Inieetfon Wetfs:'In addition to sWing 8ie form to the address is 24,
12.Weiteansfracfio I method:_ n jr-c-, above,also submit one copy ofthfs farm within 30 days of completion of well
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DivtalwaofWaterResooaw,UaderamanBFieslc toaOoni:,oipro
FOR WATER 6UPPLY'PPELTn9 UNLY: I63bMa4!�t .ce("xn�er,Belet�lyNC�7699yib3G
23a.Yield(gpm) . . Methndaftest h 24C.For blamer Smmly 8r Tni Ia addition to sending the form bu
13Ii.Didafeaon the �as(es) above alto sobinit ane caPY of this farm vdd&30 days of
fie% Bmotmt; u»e�i compleion of vuell can ti�tipn to the county haft department of Via coanW
wh8etonstronted. -
FaaaCrYJd NatltCatp]iaaJ?epanmeatcfSnvtmnmmitel Qaaltty-Divisioaof WatprRu,catces Revlsed2-22-2016