GW1-2022-09788_Well Construction - GW1_20221027

Ci��+wa1Ac W�lti Prtlllnta
�_r
� tr h NIIII Uq"
vt•R
t.Watl�'.n►ntrtatnrAa n' -� � . _`"`
R
Well i onvvAis Un lit°
•
2$ � Ob.
It:Writfnallattmt`�tliie+�itelttdntnlY+ � if;, I'
n p n.
+,nmpnnyNmm� ,. V 1�• �, ►--
x-Well�CntMUr 11a1i0nlRtRai1 Stm
i.tsra8 igydlerrbla tvenRVNts+nlmlen
&,%VJ!il Jig(,awt*Hdl nth: T �
Wtttarsgp*vall: 1(Pubily t} a t""
A�rictdlural ¢�
R�tdaatlat Wetat'&tq�piV(sMbiv) l
Ctaotfl4t+ttal(i�aaiiii!¢Cty) idolltiel WaterSuPPiY(4�itC�}
U�A+�ttrlaltt'.t101ta4tolej R" �"
ittt ion IL
mm w'ow:ittplll7l!rdl: r-I R --.---n� 0-
Mnnito
n a4tinnpranndwatax �cdisilnn -
rtquit>�r itaeltee�ta ""gauntry�raier �. �"
aquif�starltAGtaldiai�►� �gcnranv�'�na�' Q• _� H" '"
I1qultcr Tt at byidepcc cautrol l .
Cxperimenml Tcat►mlllflsg �--�• � --- - ,
C.Mbermal(Ctood;L,") t"Ya Glider$21 Itotnmtts) tt• R r, ,
{letrtGactrmt Hatttitl tla iL�nm - �i', _
Wcii1)1!A.DAve-M4010)i"m4tetph ---
Sn.R}!itL
I �l + [p11(i£+RR�ilnatdr.) Q, ' •.i
lFacilitY �• O /
tnUkl0h%71*fumoa . r
7 c.a
I+l,y ni Add[axxI Gllx,and VIP
�f
• pnteat fdututllaQtiPn Na(F� ~•"^'--" -.
C;nutty
atr.11.nntaen Red t+Ml�lnQtinda� �innceviaaenadanxdcc3mnt�egrtsaa: �a. Hnn;
(ii�v�tt,s:UonngtaMonpi»nuilfrdm�tl 6 � •�• /�� / �/ ��!
Q� 5 ��•��:� a,.,...,�� �5 (_,[1_� �• �� icy °at`
m
Beat tlr R° Hltl> �Mr gin»r h�tvcatip om air ate}reap(H+r+rJ �prr �-0Mn .r
6.In(are)ifie welt(�I h�v.t+lAi+Mt_
err t��JYCAC nzC•dle4 or 1SliIthuoWdf tnWM'!tC
:.Inthinaca alrtaatl ad�wall: Dyes or p rrRYofdr�+nrnnthnr�llebpM►'kk►d
/pd�trlsor.J111a�rkrmwniwJl.ionxln+erA+�► u lalrtbr_ur�roneRtJ�a � dt
nwirNd Ulf mWrAsx tMl1firOOlp:ha OffUs ralm• t „�t�Itebadknt Pm1doaddIIMl11g1 Me MID,en�we+ti
A.ror iieagnebeTPT er QrwaeN-Vamp�eolTen'ntnt yVeitft bRvi+�the sAeite u�i���fltlflli.9. Ymt a►AY abro tltAaE1 addlfiamll R%Jpo IfOMM"W'
Nnn9tmaAml,gnly I GW l iscmded. y tca'CO-PAL NUMBM Or+wrdla I �
DEAL W�tttt subnitt ttiia fbtm wltllin 311 days of cptap7allon aoer, }
'AVa"t%vm&Pik itattttr Irmo aprSK'S..- (Ai:b RAp.DE �,—
i"nrrxntllplrxKlhtLtr of,drntlu fdl�eNmr(Frt+nrpAi�t��AQ'orr[��Gt1Rnt�7 mngltgetftlatolhc1DY11Ap:
.. Mviwinn or Wniw Rnnra",�ldltnaa►lar►1�t444M�1I Ufli�
' x0.8tpIFaNntortav�lbniawtnpofaatlin�: _._ <R� tIF�7MaR�aaeatnn,Rfi�M►� 'tiw
I/'xatrrfam!ts,YhgRecttrh9b sac"•" 0@ 1* pddlgRl In248
G fn addititre tb It eg tlta �ltm nf'wd'
tir.Nntrltatedirmetcr, /o v�(i1n.) ahnva.af�Submit onacaPirotWUs flam wtihin 3Q+Mlys+f
fx.�Nejt dnntrlrrgeetanthttldt /� '�� a�ub�nt4+thelltllatvind;
ii ougc;mtap;ce$le,Qlt9Ct Path,utG,1 Alvistert I►t1�A�T Iltaatireah 1JaAtrwgal+ettad flit tool►Cenll'al l'el
t Ceffi M+►tl�>�Cet<tet•,R11ie11tll.I►id.`xJq�t®6
MYt wrRTF:R S�'PP1.1/t W�t;,L911IV1.Y: fl1 AdtllGen td tumdleg fie tbtat m
S� Mntka4arl�r• �` Iltc o£ihilt Potm wtOtl't 3Q tteys nF
nbovq 0190 FtibaliL a�
tbC JiAth>3SA(Cf p to tho matnft)'INSM e£thn 10,
of
►.91N010nractinn type;.......-..-.---�— ��ouat _� eatttrRlitw-
I�nrm Ci1M-i 'lVerthGlRotimtAapnrrmentnPi:nvlaSnqu:atlltQmWltr•m���e�t�'�t'ROR Rea�teA2•�4�Illb

Date:
Well Case: �IVell#; �'D'a!a — Do o C)
Name: Drbe-n Sal ��
Address: ,-,)% S NAC ICOM QC�
Pump has been installed, well head ready for inspection.
Sign:
C &rw7afQar Wak Drri ti*x.g