GW1-2022-07665_Well Construction - GW1_20220818

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WE'LL CONSTRUCTION RECORD(GW-1) Use only:
For Internal 1-1
I.Well Contractor Information:
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3.Well Use(check well list-):
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5a.Well Location: 25
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21.REMARKS
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51).Valltude and Imigilmle ill degrees1miniffesiseconds or decimal tlefrces: _f_c__'
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22.Certification:
h.lqsirv)the nell(slo I'vi-manvot ill- Im Tenlllorar\ IgnattlIVIK milli'd ell�( no­wi
Hi ,this/tim, I he"'b, l.1-1111V yllw,/I, ".4ir"
7.1,this a rel,air Ili im v\i%ling sell: 0 ,therm,:,m
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....... ...... 1.3.Site diagram Ili-additional wr�11 details:
N.For Ceoprolov/0111*nr(lowd-Loop fcothernial Wells having the sainc You Ina,v use[tic back 4;hla fvy:In rtm id:: sir .,I i%,;'
colisirtlelloll dcmik ),oil omvako al Iarb iddil I,.11al pap—11 ne�'ollary
tAllisiniclion.DoltI G%k-i i,nccdcd IndictsMFA1 M'AlfA1;R of .%clk
drilled. SUBMIT'lti,INSTRUCTIONS�
1
9.Total well depth b0m land mirfacv: 55 (FI-I 24a. For All Wells: Submit thi tmil "Ithill 11) (Im", ill
con'trioAlon In 11IL:1611mvilig
10,Static%%at(-r level bel(m top let ca%ing: Division of Water Resoilrevs.Information I'voce%,ing Lllil.
P:­(­i, 1617-Mail Service C cutler.RaleiLh.N('276911-1 bi
11.Borehole diameter: (it).1 241).For Infection Wells: In ad(itimll I.,vc,,dmj.,the lomi to the add es.,at 24a
above. also slihnilt one copy of I0 days c"1111,10lion 1,1 ,-,-It12.Well construction method: ollstroclu'll In the fiAlowing.
o-wri. A", i-C t
Division of Water Resources.lUndmiround Injection Control Program.
P'OR WATFR S1111111A NVEI I S ONLY: 1636 Mail Service eviler.Ralvich.V 27(,90-1634,
13:1,Yield Igplull Method 411 lest; 24c.For Water Supply& Inieclioh Wells: In lold'Itt'll to
the ;Adressics) above, also subill"Ilt Olie con this f"im k'167;1, "I
131).Disinfection INIPC:, Amount: completion Ili well cmistItIction io 111c comm. licalill (1cpall.11col Ill Dec �0,1111%
where constructed.
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