GW1-2021-01882_Well Construction - GW1_20210429

7.
Feb 1619 05.43p CIearwaterWell Drilling $ 22-7241 P;
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ficattltxtnni H (tetytn wxiar:g21 Remarks
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rny�irol Addmu,City,and Zip
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,b.l atitude and OWSUMde is degrees/wInMe lstcoRdsordtcimni drgraas:
(ii��et2frttebatxtsttMmgiaeatliat } p I ?100Colon..
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drilled: „_ .
a"atsit wall*pm below land antiitca— _ .,. —�Q•? 2ft hCALM Eli 92t6Qtii2 Ws fomt Ntlthin 30 hays of completion of well
rarmrdupfr.rNttUWwf;ddpfA,jrdVMwf(rrnatpk-7ilMA'mtots�ittnol cirtlatTBCifantotliellrllotcing:
f H,statie wanerievo bet w tap of taping: _— ..._..._00 Division oft>aater Resuww%Is%rmadon Prec*dtft Ufft
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!i.l3arerroiedtemader:, ��t y (fa,) 24L por.Inlectten WW„iet to aMdan io tirmding for balm W the address in 24a
12 Well Cti7attt Oditilt method: i V vj)"v,MM Aubmh ale aapy of this form Within 30 days of txrttptedm of wet(
(i o,anyc,tasty,rablo,d'+sats ptuh,s{c.T ----�-.--...•., p?tdi[eatim!It>,Ihr fOtlaviltg:
tYfR WA R Divftfon of Water iRteaunw&iUndetrgtronud Injecdon CoRWW P�aai Mj%
tGiVPPf.XW$L.I,�ttYNLY: 706 man sovtuece mr.Rat*kWC2'7k9tti.tia6
13a Yield lRM) of teRi 2tc.Ror Wa tc-I �,,>�is&Fxkwdan yVeihe fit Amon to ticaft an form to
the nd*O C$) aboVM6 also Sethatie sae COPY of 11119 fbtar wHhln 30 days OF
tttsiarectkgt
type: A Iltatmh anmpletion of Avd) iorr to the caway hoeph*w m d of the own
whWe aortuttttued
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