GW1--07790_Well Construction - GW1_20231201

WEL1r CQNSTRUM'ION_RECORD -
71i Rai ma le wed lwsu it reLtlititl..gpy Per laved:Um ONLY. ' �
1.Well Ciraltscur Tates si;:I,r., I-
WelNotse.x1.,y laic It j'i,PKlS7ti�i1r -._...__.._. _. .-���
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Ne well Coofre!.Clrtitut+eu Kuwt a, * T h r ';y���;
SZ'r +' .-_�a L.� �.1 Le_ �,t L�ir. f ;tip!?
1 L " i.y '_sl 11111 S ;ed= tu' 3cLiL
Caspar Naas
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I la.lwrJta mimestat4 ) -1
2.W.0 Q.M►otwr.?emit/: 3 9/ / 57' A:L1I'- .fiR. rim .rAutw,.
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ottulwhuLUConswv 1 aws>SY� RrsLdorti•t�,taca 9t uolr(inN{a) 4' h' l' la I
0ta,IdenWt%W:ei Supply(td,ueo) 1 C_.,, ,• uI
.♦W tOn 11 ■ CF. 5m 1!.-•.1 ,c.,..''.TIT. rat.
oldonhorse awl'Wetlt K-i• C1 R 4ph*U 1 /2.c. r-A
ORau,rery . I ••Lt
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]0rou�vMtcPm.dulitx il�f' ;t bs � Na y' i A tMl>tt L•jg lIOAtidrS Slumps F .nrery USaliniryDirtier - A. r Q W6v Yen
'Zolwmwotsr Orange
t7Glper:ectalalT�eh'riogy w
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O(kttth rmtl(Claud 1.4J U'ra�or ' a CAC(se M,YN...4 bidio¢irilra:wity. ••. • ••
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physical AMIrµ Cry,.� h .. a e. A r: r
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Cowry Tame:J.wdr...,,is MINI -
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Sb Ltiitotls tp!Longitude it ie)<rrr./o,iattadweordt or ekriari I , ."•-,ti'"'1)ar •i•'+2^.l l;F,'(
((well letAndis,vl8elat �,.� '�
( tielQ one ) d.trar. r
27.l.rtt aAou: CitVi 'c'Ut7
(a Oda �R'7� /
it.Is(are)flu'OW: itPoressaorat or tsle arc..,.tir1.1 e l r.rir�rrar Dote
GT,,opor,ry
T.(,ttt1,a Te / •iAatR ram'Jim",/lrraity Ia.y�!ire el,av(11►1„ea lvuaJ uwtrsetr,/rA aI eorl,or•,a
Nr to as eaietiag well: QVu ♦T oyo WO 1Jt 1JG1C OT:`.ttrou w 00A mC:4•o a7QP 1Ll/Cnntrwartdh,a,ime rerun.
oil a 4 a * * ors boonwill sown‘ .i. r ^V'•1Mu Arapgr Is,Nen frwrlrl so to,Tell o+wr.
npui.wilt.r71 r+worL..c aw M as W Mre w A find crr�ak iar(yarn Q/Ow i
2).She diagram sr udilttoosl wall drtotli:
I.Number of Mdb eotltreLe(ed: You:uay use Use book of this;page as provide additives'well site details or won
fvwl/ANi.yrcMp,�.N..rar sic c.+n,tnmt.on details. Yet4 slay also Weak atdturvtal hJlse Ifn.Ntwy
mesa' "sits War rot.AI l a ar�[jM�fl WPM.youLWI ;
/�•n C� W!I(1 ti•AL INSTIiCl IOPIS
n 4
- Y.Total well below Lad IWoe,:
favawlaptrrNVrwrNtpvwl/dl4tiu(v w. 4 .�7Je`.ad 10.7' thj 71a. rig All Wet iutfn,it th:a tarns within 1C days of cvnplaiisn of WC
CONE riion le the f folio wine
1I.Sgyt w air level Nisei ttp of wins: -
r/,.n.In+f„aio.o..;ingwe-,.- ifLl Division ofWatr vca
,inforwtliooTrrtagt;oil,
- I617 Med soreicaca Cou.uaw,Rai Nf1,NC 17051.1ili
11.Doral,oie dlawlar: .6. .1‘. .. i114
-'1b`I L&Lw a tcl)t:I In addit.on to sending:he Ann to Om address,a;a■
U.Wig cetgrrrtlgs seta.__. 1 y. f r ware .. , eu'at' .Cr,. ,of .•e h. % v as .' days of Completion of wets
(i,.semtary,eats,di:-.tp♦pub..; ) lcl--�--- c qr rc:. •o- b fa ow(r!
FOR WAtYiI sums— ,--WZCL,-O'f1:Y: - )r•,sk o!VP., • ,i`u
b, -.gn'._ ,,ctioe Coates,Program,
// 1tiJi mailSre`Mia Crime,Raleigh,N(`17i11.1tiJi
17c Yield(sps) _ M..:,.d N um.6y t(o( p W h 24.1r Mks.d met as linettiot.Wellu: ((t mild/on to loading the Sum to
Ill Di,ialsstin L G r 1 h t? the adtreu(N) above. alsaysubmit ens stogy of this form within SO days of
type Amount: ckmplation of well coessirvetton to oho emu*health depaio,a-nt aa'he many
-% Wham cvciat sled.
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