GW1--01100_Well Construction - GW1_20240216

• 82B-622 7241 N•'
Feb'1519 45a43p Claatwate1W9il Drilling I .......
'WELT.CtfNS'i'itTG'1'IUN Rai' {' •.x1 rartntemat Ufa :
1.ReAntratity Int ation: ---
Well Comnpet Warne O.
3 - A -
�Ayell �a,CatltiealionNnmber ►�•: ' 'c l� ' n= L �t�1.;1._ s. •..r�:-• .r _�
, e��wr�� )ell t�r�I1 i �� �_ . -
� �'�, � '� b:?� �,�� .tea 1
t:omnnnXNams 16 Muslim.
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J g4.�.Vi J ! nee sumo* P95
2.WellCoistraetkanderlailt.E� r� - �E
List all t tllaaete will cadoraallospaiatllaau.111G,COMO,$1014 Priam;Cal
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3.W 1I Use(cbaett well ii e): I
Water Supply Well: t�zitor io MA at4TA� 111001ltne 11K4111Wit.
a AgriculttRnt OMmilaipat/Publlo 0 a''
11 Qaotilcallal([9ealing(Cog1hig2uPPi) Roidenttol Water SuPPly(ci40 tt. da.
A IndusttiallCommerold trash 010111 Water Supply( l Glow . L i Dt4Atio .
nrt
Mil clutaal _I s 11. �Q\11� �l
iV 11rnler Supply WOO. � I
*Monitorinngg ORS►
offer Reship t7rmmdwatcrRcmadisttun 'f9 0.4141142411L PAO,U •.1,111040011 :12 ,__._._.�
NI 1 Aquila Simile imrt Recovery JSalitlityBafles rim,•:Tt:1 >►a?J arl'rl e
ge �Qn>mtwatei Drillytg se
Aquifer Test ta" .._ a. I 1`
11b'xperimenta1Tadutnlopy T:5ubstdeneoCount - .
®Gcntitnmlal(G7esed Loop) On'"ccv
g-Rli3.PttO LOC What
MI exothermal ftnetinliConlinMReturn) nether(otgPlainttndortl?l Rcmutks) j- tt a. t. `�— CVt'•}'
1.Aait:A*1111n)Cmreptote+l:4 r IQ-24 -Waii!n t . , tt
5u Well t.rttxttinn: "lil.O. Y�.4�t
I t
Maid OO / R
cilityla n w a P" Fadilly Ni1(ifospliash;? 0. O. • .-I
P rsii addraag city,and;?p C !.�,J �'s I _`
1.1L to c
C..uwy Pineal tdomifiaa lanMANN) I
8h.Weida nod longlhtdeIndeg minutesfsemadsordC tlnddegree.. I o '"r`i: '7
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ONO field,toe bakingianofiiefent , t � 53q
libili I L_ T------
si,.P. CO(. ont °�" `�°�D ` Ci
"Woof•. tfi Mal Olio
b.Ware)the wtlt(t) thrmantnt or �1raCy yarn..r parson&chat trig>rdt(,r}leer(N'em)committal Ia armMance
I,v $
i.1s lids a repair tnnoeitttiagweih OYea or to will'ISAw. 'OOC.Ol0DorTSANeAC10C,Ah(]0 efiCmmtrncttanstal�darri mat,hala
Ifthlriv:r,r�tair.J►llo ulhu+wntodbennarrneaonl +,mmtongabs An .1nmc(p i, Am alibis Neon/Mateo paid lntt!INII
me&tauter 121 remnntaaavMn wan tfre4catoftbkonn. I,Sue tilogransorrtdationdwalldEtlIl0t
E.For GeolfCoTo/DP 1'of Qnt l.ntijt Qeathla ttsal Wells btwing dtcsmrio co a tort►tse the s. of ibisalso is ch Walt iitpigeoos!wall detain or well
ennstntctinn,orgy t OW-1 is needed. Winds TOTAL itl[JMIIER eviclls
a�nsm►uitxl ttdmis. WO May also i>7htnh adtlit 1 Pages if nonessary.
MUM!_.., - - _. • §PEit TITAi<a.A SIXICIT0014
9.Taint melt ecReh bow,Land semiRca 30,3 (R:) 2.1u. Wor All Weir Submit ON�Th withi 30 drays of complction of veil
irsr multiple writtattat deptAtifiiffarentrest+mpta-Wt n' neiaa7 0111911uciiont0 IOC Ib11attlnE: I.
In.Rtntin water level betnw top of easlogt W V (it) Division of Water Resourea,isdo *lion Precedes Unit,
l iovertu0dfrnhawtemat&ow",i` 1b17Mt1Srsvie0 Chalons Pittaighsi(C i749
II.Bore*dlamctct: 0 !g (In.) 2eitt.11EAR1e4100n WYa11x To addition to wading the fling 10 tie adition ink
trO 3r 1, pk a *ovc,also submit one copy of Wis fnlm within 30 days completion 12.Wen constriction MINA l v 1 wV`t ct►nstlacliorstt►thefollowing:
tie.ave.,mratl%cable,dirnetYnu1,sta,)
_ Mvisten*t'Weter RealautoeaeUndctgreendNicoloo Central Proprame
IN)R WATER$t;PPL1t WE1.[.S ONLY: f ,-. lf►3ti MAI1Strike Ct liter,Ritlafg11,1 C�7t�"tA6
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13a.VIM McfhoB of test. - 2 w.Rey Wstcr Rnrtnitr&Tafaatl0�e110 la addition n sanding the Ram to
'0
(ttt'gU . the tiddlcs(es)abo1e,also Submit 004 Many of Itts form whldn 30 days of
Fah.Dlsinfeet[an types Aiflo camptotfon of well const+actlon to the woody health deenninetlt or file minty
wham coanttltted.
vim ow-i NoAamIlrmOapartmontafi5wiroemuntal(loft-Division of Weer an auiees ' Redo12422916
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Wail Mar Seill4hrout Cordatadam
Ow n= ari( I2thd Neww*
Mitten e.) L-----)1166
Pengt Q31-01
hereby cettifIrthat the abeverefermed well was grouted appearance in a with
CeuntrWell isl &
wen Miller,. QM1,-(2in Smelt
Ceitika03#: —A DatoGrotied: -
constructica Grout
Total Deptic .305— Typa
Owing Thielows: in fiteq
Casing Depth: '01)1 Depth; A
Dino= 0 Li
Height
Drhre Slat
GPM C
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