GW1--04051_Well Construction - GW1_20230622

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Fob 151905:43p Cleatwater Well Drilling 826"622?244 p,1
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x.Wallfio>anlrpcllauPeanit# 7 �: �� - ... _,". !--"�.> �. MINI in'Last all appIloallte wit rmatntallop powrllsILu WA CONY,Mar';V4 V•M4) fa.D. h
3 Writ isle(e welt wdl ti I
Water Sttp�pWell: - - - "IA N 'HAMl>rrft firstfilnt •11c MAMMAL
43 Ask:ottarni unittipnUPublio 0iR �- �°'
NI ofarma7(taeatinglConlingSupply) Re identiol Wtaor Supply(single) """'-•0. • fi. W.
Y induattietlCommerotal EiResidmu nt Water Supply(shared) - apt : - I
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Inafction Will: ft. il;
it 1 Aquifer Redone DthrnindwaterRemediston likSitalfilaRAVBL C> ..,.•T-•-i I
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110 Gaperimental7'adntolopy
Subsilcnaa Control H- I D'
illi Gcothe ntal(Closed Loop) E'tca ties'h , +:1'"` :, - .ttr•U,.rosud t
li Geolliconal Hestia Return Outer el in andor021 Rernatks) - a. - c`t� tl' Ihn.HAD 4 V
rz 4.Date WOO)s to `lc_
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!9n Well location: ��Z°' �5 � f�`��1
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Ytdlitl:'(tnnet Wight • Facility OM(ifgtplkablr.) r"Z ti.—Car L "-..—.r,
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M Aileron,Aileron,cAileron,City,and Zip at,ttffiNAQK4 .1'd .i A -2913• t ----
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sl. Pertnaaead GO OTteMPOrarg
signatureo!Osaka tmmar Udo
lAr KEaiug MK farm.I herrh co10 sisal dia nei►(s)lass Omni)commend!a oraaremm
1lathisa repair tnan matting well: OW or Siva nod//SAJ't..tC 92CAi00nrtSAN AC0 PivridEdiatkg 2 1 eflCooann Notable( i,An,n
Iflhdr1"Malr INauhnowntwllmanna:Nan4tld suatna and gigolo the arum griha MAYoflhii race Niarcbtdt
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invoir under A21 wino webs»nPfm1tti backnflhlellno• 13-Site tpoiirant or additional W U t
S.!!orGeoprabdDPTorClosed•t,onpGraharwaiWellshavingficunme ran' "'a° k oTigi€prigptaprovldaaelffitiottnl+t 1I Iisomits orwatl
txmatnmtian,onlg 1 GW t is needed, !Woo TOTAL NUMBER orwells commotion Mails. Yon may also Mich addiCt�l papa It necessary.
drilled: ,.. - . — ammituraLEMBEZURA
9.Total welt depart Geier land=teem ``'5 lit./ 7itra.JFoI An Wawa Submit this him within 30 days of r-0mpldioa of well
Far rattketc wear litral degarifrfyfeamt(maple-3(1410ramr4@lno) ennstfln#ion iodic fdlowlitg:
io.Stone waterloo!below tap of caaiag: (it.) Division otWater Renown&iaibrmition Procesitag Milt,
1f.rirerfoul Is Awe earing.toe"•i G 1617Ma Strike motes,bate gh,14C27699-1M7
11.Rorcholedlamoter: 1 0 „(in.) lib,Enr,bilsalayailly lo edam to mall the Amu to tie Mons in 2An
fit/ ft rdtmc elan submit ono copy Otitis font within 30 days of completion of welt
12'WO ct netroniommntiodt o►onienctutnto the folltfwiltt
(i o.No,many.Oki,dint:pub,otc.)
visio Rttto ,Nneuud yNcetlonFOR WATER t+['MI(Willa ONLY: 1036 a asmite esicar,list NC�7t 4636
13a.Yitlgpat) I 0Methodoftoot (2 1ef --mnftrWsr
.UM'Wilier Sumdf li!I fon-Weia: to addition to minding tot ram 1r
1 the uddrfss(es)tibms4 also submit one copy of ibis than sehltin 30 days of
t3b.1)rsinfection types,,, . - Amorme: temptation of wall consunetion to the amity health dennitmcnt of the county
- whore opytaaated,
bean QW"t WorthomonnAepmmnnatorawGunmmta1Qmdtty-piastre aPwl=itmamttns ReurseA2-22A016