397286_Well Construction - GW1_20110829

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North Caroline Deportment of Environment rand Nature) Raouroc.- DIvl.torr of Water Quelhy
WELL. CONTRACTOR CERTIFICATION II 3COZA
1, pe?NFECTtON: Type 1�_ ... Anon
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IR WILL INFORMATION;
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OTATI WELL hERMTIIge )
DWQ p OTH[R MOAT INN appeoabl•) jO -�eO
WELL WI (Chock Applicable Cot): Rea lOrmItel Water Euppy eif
DAT! OttA.L*D 12- 1-1 O
TIME COMPLETED 3100 Am O PM ri
A. MOLL t.00AT10NT
CITY: COUNTY Urtba
Lard
TOPOORAMIIC I LANO'E1TIN I):
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4 WILL MN
STREUTAMOROI �u� r1Rm&eoov_ L.
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Stet,c- Zip'221
414
SIN oodi•' ions ntmblr
ii. WILL MALL
TOTALDtprnt3 551
0► Ka wou. RI PLIICs ammo weLL? MID Kr'
e. "ATM LIME Wm Top doming: .39 FT.
(WSW M woe Top of CaNnp)
133 q' CAM" 1 FT, hbwe t.erld !Wm'
'Top owrlpllrmite6ed odor brow land mine mar roqulre
e tiellertoe h e000r0er ** vflth15A NCAC ?C .0110,
W YIRD (ppnk.,.- METHOD OF TeOT__„
May bu In diem",
minutes. monde or
In. drioirrwl Ibmnt
From 1 33 To
From ' To,
From To
�. CASINO:
QteM ter
From 0 OTo h C-r 1 Ft. i°g"
From To Ft.�_...
From To RI.
r, ORWT: Depth
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Fran,
Fran,
From To..
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Attu.,
3 728
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11, OANO/ORAVEL PACK:
Depth
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from TO Ft.,
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11, REMARKS; information Processing U 't
100 );MIT CIRTtFY TWAT MO WIu WAt CONIVIUMIDTN '40FG". Wing
ISA MCAO JCGS, W/l.t QORITItUOTION ITN10 ' PM
A COIN Of ES
IICORD MA1 KIH'ROWE° TO WI WILL CWWHR.
aZ CO
>z►e L_ O veR
R OF 8 ----
Subnik the OrlAlna) to th, Division of Water Minty within 30 cloys, Attn: Information Mgt,
1011 Moil 5wyIa Cantor.. Raleigh, PIC 27099.151T Phone No, (919) T33•7015 oat 555
Fain dV�It1,e
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