GW1--01096_Well Construction - GW1_20240216

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Feb 151905:43p CIeatwaterVVel1Drillinfa 828"B22 7 �41 N•
AL/ELL cQNSTRUCTuO1J RECORD(GW 4I For 1nirnnivanOnly:
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To
Well emennot blame it. f�.
32
ail CnnooelarCeoifiwitml Nimtlkr e i t' t J ( � r;s :{ .. I l: �- '__1`_-sL3_�:.:. : '•
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i.W U Comttrpo11a0Permltd: In 1 31,E - � � YY,. . - elantcren."II in.
t all ty2Wlwon v t te wrj(r atutoo pima RA GanpO%AYatc,iarrmua,eft) ft in.
I Wed Use(Mak well swell it. —`
WaterSupp(gWdl: .. 7. • -ts a t fit errata l t►Ti6 AL
II kp icidtoral DManhdpailPubllc '0a' �- m'
111 emirlrrgial([9eaTing(Con.nagaupp1y) mtdentin1 Valor Supply(single) '""' 'Q. ' ft.
11 Industrial/Commercial esfdcoriat WittrSupply(shared) - I
fni@mien ppl_ , . . ._ l [t. o�Q a' Pia -j -�61
IVnn-1�'nlRr 5n v Well
a.
4 i nnita :a, *Roomy ft. fr. I
MP Amnia Recir a riGroundwatoRcmcdiation id •.N11/B' VI1.P r. ...
41IAquifrSure/1emiRummy GSltinityBntren Fl■riil:7Yiy,'7,1 $ x:` a
U Aquifer Test .r3StiminviatirlDraingo n• a.
I i`•.aperimental Teelmor OSututtdenea Control 0'
I Geothermal(Closed Loop) DiPtater a t IsLr L 4 _:�- .,....:-9�'7
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II eieot orftud ofeetinvcoolirtil wawa_Dotber(exptniIt a derfi11 Remmkrs) -1 ft, (o? sz. 6't `t /r '
.1 Dm WOO)Cotoplaud; ' -0 -ZT Welt I1)1I 0. . 7 a A I A t'L4
se.Well LacaN � fa � VI' 1_nn: -
Can• OS' ii _ , ,
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i�adiity:t3nnerumne . Facilitymo ctftgspticab><) ..._.-
P Adtrtas.Chy,a ztp l„trans I
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County Panel tdentifimtitarta(Ptrt) .
fib.Waldo nenlon deindcgteeclAdmrteilmeindsardcelmn1&we= tn1:irrO:ic "2 UM
(iitcatiInW,on4titAoaaiunUWcnfl .0 dons dCii�' +
.6- 11-3�13OI N ?a / 5501 %�L j )-it- 2.
sin erckdlrm[We1Tc*tnmter 1 w
6.Ir{ane)Ndewdt(r) Pamaiwtt or Dt7�etupnraey I '
14,.at date Arm,I ne,Phvomatd�ski Orr net*Rm tirarl connoted is acunr�rcc
7.le Iltts a repair to as adllingwens Ebro or No Wile)9ANCACCC.OIODo iCA RCAC MC.MOR WWI Crattatetta»staha'atris mrd Thal n
IffblsJrorepaln0auktrnlva waft exastruconAtl6jn ianomicp?ahr&s oon:ed,„ a'AyafdtIt moot ktrIrt matt/iathewellowne.
nweir raster G?I=Arise wzttnn nrenihe bawl ofthisform. IL We diagramor addltlnstitsca tdedttbit
&For GeoprobeilIPT or Closed-Lonis Geothermal Was buying*emit You may use the bock of quspage is piAvlde ad,dltioslsl Weii Ate details or wen
oonstni nni,oaly I GW.i is needed. icisto TQTAL NUMBER ofwcits co natNrtio11 itdails. Yelt may also Math eddlIkinal Ma if tiaert01
drilled• t
i 1'atat+veltdetrlTs tnrlttwiimdi;etrlhera ©� (IL) 241t,fir_ r 1a: Submit this lino wind 30 do of completion or veil
Far mHrptcwettntistafiat thriire aresftrample-sazarantt 61069 gmytruciiontoihcfollowing: i
ie.Stade watertovd below top of tnsing: COO (mil Mvleloa of Water Kewtt,emantbrtti on Processing utal,
►f water twat habitue emitgwe"'II / 1617hi dSin'viaClete Renal 14C27699-16so
IL Boretiobedlametar: � ti W (in.) wh•Reny hrn iell.3 ells to addition to the formto the Wren in 24n
AZ Wellelrn[trragmt method: COfa4cei *ova,also submit one copyedit&ft 1m ati htit 3f1 stags sd eompletlrtn of well
ainsi[natimsm thcfati[nxhig
tic.maw,raft.cable,(greet perk,eta)
Div(/ton°CY KT Rummest Vndetground injection Control Program,
ma WATER Wil(WELLSONLY:_ E//�1��, � 7026 Mail Service Cain i,Mktg",MC 7t 4t..7636
13a Yteld(gpar) ZO Mefttorl at canna_.((,�L _ll2 e.Qar Waiai'Yllitaly&t(iitecI10 t Wet0a I[(addidon to sundbtg ibe ram to
1JJJI hC nddnss(cs)sthnve t so& 6R6mit�ofo Copp Of thto(Cain Wllltfn 30 drain of
M.INsinreeffan villa Amoroso completion of mil ccnstatction in the comity heaitb depmtaent of the courtly
where conalmctmd.
limn OW.4 NathCo,niirmDapmimantefiOwkrinmu inl Qua*-Memo o$WaNrttm9naT Rea&ed2-f24s16

Will DiWar Sell4krout CNMEImam
S/ YJA' NawWdIOwner: / .kr-
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Permit W .31/ D 3;
I herebycertg'ihattheabover ced vas grouted ui appeals/mkt acaoodanoe with '
all C.ountrWellrate .
wen Drnier.•�,.lYl.�v }4(le/)
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Construction Grout:
TaW DePdt 37c LIIi '..i
Lucy` IVZ
Casing Nee 10Y : J0..
imams= Io%
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