GW1--01808_Well Construction - GW1_20240320

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This form cant a used for single or multiple wells For Internal Usa ONLY: I
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J.Well Contractor Information: j
- Rex MeadOWS 14.WATER ZONES I
FROM TO DESCRIPTION
Well Contractor Name ft. I „,
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NC Well Contractor CertiGeationNumber IS.O[rFER.CASHVG(for mu[t:-ctltiyt ci[s OR MEMO!
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Clearwater alV�.f!'DrillingInc. r 'iL THICKNESS MATERIAL
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5b.Latitude and Longitude in degrees/minutes/seconds or decimal fees: •-"'
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By slgnng thS•firm.1 hereby ecrt fi•that the trell(s)nrts(ir re)constructed in accordance
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with ISA NCAC.(12C'MOO or ISA NCAC 0?C.0200 Well Construction St dads and that a
7.it ibis a repair to an existing tt°eil: iD?tes or AND copy of this ret cad has been pm irled to the twit owlet.
?flits is er repair ill ma lawns*:tell coramcticn t orn:Gaon rc,ut explain t`em-,.'rre aftlre
repair under-:lrauttrits section or on the tack ofthlefant. 2.Site dtage srgildi[iata:tt wen ct4.Rita:
You may use the back of ibis page no provide Witionai well site.details
8.:�untbero,jells constructed: co» QrxTll
. J-irL'^...rtiS d:hi;y You may also?i('%-t3 3(i?flti•?8i a��"•=•+'Farniulslvly lnlectkm or rann•ftYra.rsrgait+[calls 4 aLIt,,J:the some.Fnrcc? m_t?r,r,.,; h !itie k „r J•,
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