GW1--04831_Well Construction - GW1_20230728

Feb 1619 45:43p ClealwaterWell Drilling 828.822-72A p.1
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-'WELL C SERVAlIEON RECO 4GW-J) For Ttt(etnni Uao day: t
I. 1 Contractor InnformmlOn: .�,,,---- ..^ i --
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� gaif`�r StpraRa end Recnvcly Salinity Border ',;��ix7��
a AqultirTrst Ei.iitmmwatcrlDrtlnng r
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sp.well lineation: Lf Z 413 t�! .. .1 I •
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db.Littitudn and limit isdcgreerlminmesfseraadsordcsimnl domes: --— r •3'
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6.Nitre)the wdl(/} Permanent or DIMIllpfltry SYlpmshmofoettitiod9(dlCaihttatcr Data
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ownirnide?A21 retnanttr+zrta»asnn Ito hock° rer. 23.Su*d gsomor*Mideastwrltdetes:
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►nnanretian,anlg I OW.1 is need fndicaloTOTALNUMBERarwclis aN14Wdiatltielmis. 1tDuta>AyatioitttliohefidiiicntelPe13eiftltlaeaaatr
chiliad:. - _ . - fifumlir umgas crrris_
x xoyt welt depth Odor land aAt11tCC'. 5O (IL) VON tFar_MI we1b: S theth this fbtm withhin 30 days of completion of Iva
PmhiulUple wear UmalidrNJkrY mer&mph"'.161Ma• VIM " ennsttuctiontodmliallowfas:
Ito.Stone mom level below top of easing: _ (f) Divittoa ofVYnter Realta•aes toionattU on Processing Vldt,
f yinn•tool behave wins taa"•" 1 1friT Mal Sa ida Center,it�ttdgittNCa7699-tfi14
IL Boreholeenemata: lQ ' (In.) ►1t•.3krr jldertiop Awls: To addition to son dloml the limn m fttatltldttlss in 24n
12 Well rnminaeUtinlaetDed: np 4"a. ( *ova,oleo submit one copy of ibis harms within 30 days of eomph3lat of wall
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VOR WATER$LPPLY WELLS ONLY: (2.4. 1636 adalSc roIn(ham;lt)Iict�t.NC2749994686
I3a.VIM VonaVonaMantua map map q 24e,Re-Wow Months&rin oattom Went: to u kiltion to sending Mc 0mm to
Urn nddasss(es)aluve also submit anc copy of)t619 than ldWtht 30 days of
13A,IHttnfectIon typ4 ,Agimp _ completion of well consttuctiou is,the comity health depantntta of the mousy
wham coil started. ,
F0rmON.1 North[ornlinnAcpntlmantot'IlnvtraemmtelQwuIN-Division oDWatto•& oats Rnvisea2-222Oht