GW1--05851_Well Construction - GW1_20241001

WELL CONSTRUCitON RECORD For iruemal Use ONLY:
This to can be used for sire or maitipk wells
1.Well Contractor information: _
Rex Meadows 144.WATER ZONES
FROM Aso , tirscletrnoN
Well Contractor Name R. ft. - - ___ �,_ _t
2113-A rt. R.
NC Welt Commie!''Certirseation Number t IS.OUTER CASING(for muki.c»r1t went OR LINER firaPttlealtki 1
�.. , Iitl.ME nth 1 CKNE S MATERIAL
i
Clearwater Weti Drilling Inc. I n. f it. �� in. V/
Company Name 14.1NiWRR CASING OR G(rwtbW ern daserHoo v
I l J���� ++1 3 I FROM i ID . DUU.s±erfR TtiiCKNti S titaT ium.
C.ea 2.Well struetins Permit#: 1 1 _ n. ft. ie. t
List all applrcohl:urli corutraction permits(Le.Ceram•,State.Variance.etc.) .-..-..- _
3.Well Use(cheek weft use): —la,
17.SCREEN
'Waterss:gL+lyWelt: �._ o.. _ t.- ..e _- et.vittrFx r.st.tze. rtstatirss`1-71ta xret.-
iDAgticnhurel t ''„oLicipateJblin f4 R. la
CiGeat emtei a ti Doti Supply) tsitfcutsat Water R' N` ,
t nA pp+y) &vials((single)
i Gt .riarimmes,:i3! ,_Rcskl^atia?Wrcr S (Owed) 18.�O
Supply�a } r.-
l7prripr:icr t F7 13[t_ aAT UV,, F pal".- FM.O rVE
Non-Water Supply Well: 1 C`� 1( t 1 11 1c.�( 1
unimi wing Oi.t t 1-‘)D
to i 4
t Aquifer itec:ttsrg: C./Quote-water on 1I_1 r
tat">_:5 :r7itiTL?'ieK
ClAritrifet Storage rind Recovery ^$etinity Barrier AIR. T rA MATERIAL '" `i TLA`CentENi maTROD
7lckftx i cst d7Strrm t+Msr ihsercile - -Ir- Q 1 �..._....._...._1_.]
`Cli;i:peThrtat:ai e atsiis y i3:�i::" i:�FCouto: s'` 1 • ___
I lG'eothemsal(Closed Loon,) Effacer II PR07N _ TO _ I Dr-sew.r 4tre*r hrtISS,sniiie_gft r,*�rapp ,`c+rti
3
ti3C 1/ber rest(Ha.iino ff:eoling.?-,,fro) (�i3a eel fn!ein t ID iemar s)i _- it 3L+ft /y, t±dA ! - t
4.Date Wcii(.)Completed: 1)-q -; 1 :yell IC-it ., _ +f t �5,i r_S�i, �,-f :.-..r .�..._=a ,.-1
ictfre' a)S ft - —_....
t_ , . —I. 9r_aealk i •. -....(--- - 7.i 72-1",
.... i ,—- -‘ . 7,Yr.:-'1"/
...t
cti gtt..gn..;.Nara t. !De(i`_p.i:_-Vt_, I _ it. ,-
Z t Q-,,,t—
OCT d '- 2024
1� ' et. ....._.
Physical Adda s,(sty,and zip Ii Ir f�:yt+�ti': a '
M.REMARKS
- .
04
Coupty Parcel idaniftcation No.(PIN)
Sb.Latitude and Longitude in degtresfminutesdseconda or decimal degrees: 22.Cer1I idos:
(if well field,Doe lat/long is sufficient) r� ( }
5-t 1 Cl C� N 95 < v c0 -W ice- S 'C� ) 1
Sigr MC of Certified Well Contmetar— Date
6.15(are)the well(s):Iitermanent or rJ Loaaparary gj,Signing airflow,!hereby certi,[v their the noll(s)rm(tyre)constructed to accaurlawe
nigh ISA NCAC 02C.0100 or!SA NCAC(DC.0100 Well Construction Standards and that u
?.Is this a reptil*to an existing well: 0 Yes or Mite copy of thu rer nd has hero provided to Pr well()()WPMwn
If this Is a repair.Jill oat kauun sell roturrrrctloa inforntedon a pialn the setae of the
repair ander VI remarks section or on the hack of this fauns. 23.She diagram or additional well detaike
You may use the back of this page to provide additional well site details or welt
8,Number of web tsltrocted: construction details. You may also attach additonal pages if necmasy.
9,.Tnln#we!!tier*hrsaw m oft surface: 5 "" (ft.) 24a. For All Wells: Submit this form within 30 days of completion of well
For nhuh uf6'walls fist all deaths lick/resent(e natafe-3Cai200'and 2fd_100'I construction to the following:
10.Static after levy_:nctuw tasp of ctt,siiik:�. (U 0._.-_._ _ (fs.) i ie;t•t o:TY.i-itr Qi::flisy,its rat uiit!iiti Yt*,4- 4kt,iri 1i.,
i ua.cr ictvi is awacattatg.gar -r" , G .5-. Mall .'';:;�f^.;2+.^.'., s o.4�--..--?'F c:ti,3 ti_'r
t r Rnrai.nta,t:..t,.ta,. �.Y__t O n,t 24h_For Infection Wells: Ie addition to shies/the forte to the address iu 24a
(�'� pi = •—,-...e, -§-:.i:. '.:i:, s:nrr a.-..:4':rt :'T'7 `:_+"'a r-.a 7...4 5-:; etc; r>� �cII
r1" tig7�r.IPII.r.Hn F^tft..e. 1 1 /"f�t �riglm sin i to foie flfltrpitintr
C ,;Mar ,�k,trowwt push,etc.) MV/
Maine tirVittigt'fN ty.Underground injection Control Program,
,P41Sd:VA.:P . ...:c. F l_.l.Fes?..t•: 1J^ ` ......... ...... �...,� aai.Nr�a-a ...d
l `� ll t /`
i 1.4._ an,Ul.Mr C•m...M-R.YwiarMi•Aw WwtM. Ile�.tntyi.ew M e ..4ww it,..is u.to
test it
',AL the address(es) above, also submit one copy of this form within 30 days of
�L ..a. .r__.c.._a.Y. . •--- completion of well construction to the county b led h department of the county
Palm CO-I Ne-tot tafoi,na Liep:.:ate,r at Ligvuoraileut and Natural.R• wises—Ltiva.ont cu watt Quality itevisest Jan.LOU

INGO Delft Selfiereist oweasseen
omer . AP Chtiew
Perrnit 1Q131)
t oar*that tbeabove referenced*ea wae; in appearance itn accordancewith
all thuntyWell rules
Wall Drillerz, Wei da
certfficatet; 1,13_A t CAloat
ca��tn�ct�,o4ac
Casing
TMdleneee; . M, ,c.e d
c ' _