GW1--05443_Well Construction - GW1_20230821

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1.\icit t'n;,Iractor Info ncstion: �--
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Water S e*Wel: -i7.SCREEN �_
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ierflase eltilleatitl�Ip Sys, Fgasislential Water Supply(single) It _—ft. . in '
high CiaiCmlttnaiwl ❑Residential Water Supply(shared) —
la.GROUT
O11'el Is>1110.000 UPi) 600M TO T SC\rl7U.St FMRtACAWS\T METIVOIR&SAIrst1T
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19.SAM:I/GR AV'EL PACK fit applicable)
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❑Salinity Baer FR0 i To MATF.rtty �. >
rw ouifel •si OStormwater Drainage n- n.
s'sct':ir:ie tv'T.elin,'logy ❑SuhsidcnceControl it it
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I anal(CIos:d Loop) °Tracer 20.DRILLING IA)C(attach additional sheets distesysers —
- =C„<.�z'^na'tl::atinc Cooling Return) OOther(explain under 21 Remarks) FROM TO Dta wrrtov reaa r-n,rdwa ome,cre, grits as.tr.
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S.[Tate Well(sl Completed:l I -7 well iDp a it [/Z R 2 I
t CEIVED
.a.�tcll Location: 11 Z 2 3Gr n' �71IGn► G
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..�(��, fk111G 2 1 2023
r,. ,rnc Facility Off(d'apphcable) ft R.
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t ) 21.REMAKS
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Parcel Identities'son Na(PIN) Used steel hardened drive s hoe
F•h Latitude and longitude in degrees/minutes/seconds or decimal degrees:
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a zwF.acnm 22.Certification:
35.103a1-3 —7(6 120y)02 ,v
G.;SI am'!the%elks): lPermanent or ❑Temporary 4.4‘""")
Signal eel i Il Contrka ra r ae
By atgnrng this jarne I hereby co-cry'brut On we143/.aDalitneiattt lluslaaydlpp al.
- ,s this It rem part existing well: ❑Yes or nNo /it NNCAC OX Ole0)a,/5J ed('O'C.r)'vtl t..It(` Snaiwettailataa gr
.. - -•ezmajleatbwn.n well cnn.tr cnan iufurnradon and erphnn the nature lbite r).1 rinr evened hws been prmsJcJ to the wit m.rr..
-..,0r aylj aruweelt ar.th in,•.an the buck J Nos fur t.
23.Site diagram or additional well details:
la.F tgt q t., .L I or(latxtl-i.uup Geothermal Wells having the same You may use the back or this page to provide:kMiti aeti eadlet info
ejainseala.gay j GW-1 is nixdssi. Indicate TOTAL NUMBER of wells (add See Over'in Remarks 13 r). "txt may alai rasa►,d itti.�ate j _
"` 24.StIBMiTTAi.INSTRUC IONs
la. lit�toadameiw elnWamber: 3o S_ (ft.) Submit this Gµ'-I within 3l1 Jaw of well can
WWI,01.iyrAr earl%irtaa lderiert ftet^k•7 u 07-,.taradr�j' completion par the rstli ar utg.
Q tt. 24a. For All Wells: Original [rant Is, Diucseia of Water g,.r..n.n 0%11
Ile SpMr°'IMerkttmlllWar�de`tr c__— ( ) tnlimnedioo Processing Unit t6I7I...Ram NICr MI7
if'.rm.amwre arelhnrrerais mar
lg. 24h.For lryeetiun W'clla:GOO III MR.t"n.Sansmand Iklaottian Cad imt
II leetilthtlatwtlftr. Rotary ) Program,Its 10 MSC.Rah.*t NC±'6,4,1_16 ic, ��
± rt.Ma/to rl�t � l-k.Itor Water Sapp and Open I.top Orion.rural Return Welly:whether
>.0+ Myy"-' - •.`.. ctwnty Clttironfiw,,tal GmIth dcixotru art o1 the aunts wl).rc
dialltial
FOR YF9►tl.tt)4)'PF t 141l[_?tt'r1.1 2laL For Water
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