GW1--02168_Well Construction - GW1_20240408

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WELL CONS�'RIJCTION RECOIup(GW 11 For Inte na1 Use Only: I'
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SS - cSZ7 N.$152,5/3 w �2--�1
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7.To this a repair loan cztstingwelk Dres or NM w1dr;MIMIC O2C.Ol00orISA NOW 2C;.00.00iWellCos:motiorStamlanirmrd duo a
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&For Geoprobe/DPTorCJosed-LoopGemitconllYelisimvingt esame tYxcliilaans"debtte.(bsYcan msyihisgattotuPJrio
aavdddaitisodndatiomiaafll the deM ilsorwell
comstuctiag Oily i OW-1 isaeeded.btdseteTOTALNUMEERofazlls a pgasinecssary.
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9.Total nal depth Mow hod surface: Val3 (iL) 24n,y -All Wei; Submit this form within 30 days of completion of null
thruwtdpkw.ur&uopdcprtnld'B' ( - �Q0'o1100100) construction toiiwfollowing I
1OStaticstyter'kseii luwtopoftasit -- ,)fl . (frt.) Ditision of WaterRoloarcts,InfanrattoornxoningUnit,
if wzder kw;trawl:coil*a rc'it zn 1517Mml Service Cmter,itskigh,M27699-1617
ll.liordwle diameter. (a / (w.) 24b.FrIfotoinif Welts: is addition to smiling the farm tot*address in 24a
/�.,/ �/ J r�,;also submit one copy of ;fot n within 30 daps of completion of well
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Didion of WnterResoorcas,U � ' IPkctianf wdrolProgram,
-FORWAtiiitSTIPki.VIVELI.SONEArz 14351MiailScrekeCaki,Ralciet,NC27699-1636
1.i-P4- 23c 7C�r , s4' Ls addition tp sea '
il3o Yids(gPm11 336sai- - lr. _.._._..___ _ 1(lfat ! dmntl><:f«m to
C t ad3i+sss(ss) adso submit one copy of this form wain 30 dap of
13b Dismfxtioat} �hJe /llr Almost, ) W• J of null cot on to tbo'crown►heat&dcpaument of the county