GW1-2021-03573_Well Construction - GW1_20210823

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S.For GeoproheMPT or Cioaed-IlAnp Geothermptl Welis having McaAtne 1'ou m�use t►ec trttotc of this page to:prCvido tonal
p cal%wail 3ila ary. s ttr well
txtnatmceian,enly I CTW.1 Is naAcd rridballo TOTAL NUMBER(if wells rtm9tructinn detaiis. You May aiSo attach addiritmet pages iFOotxaaary
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1.Toter well Oepth tralow land sarfaear,,., -. fR.) t�fa 6nr&LM&! Submit ills fb7m wit>an 30 days of COmPldirm cf well
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I i,Itotritotrdlttmeter: ._ (in.) 2 ^a■_ cHon WVdia: to addition to handing the than to the addrmts in 2/n
ly��1 M 10mr,also submit ona copy of this form within 30 days of completion of wet
1z We"construction method: nonstraation to the fottMViM
(i,.am-.marry.cnbk,01maptuh,etc.)
Division oI'Vtrattr RRttaurrxs,Undctrglrrttnd Injection Central t'teograta.
P(M WATER SCPPLV tISONLY: Ifn36Mgii3ervloeCcatnr,Iiatelo.NC27094ali
13a.Yield(Minn) Method of rest:-- '�`�-- xaG Irnr Wmcr Saeolt &iafeelloa Vltellr: in additiml to mMdfrrg the fbrm to
the uddr+n*$) abovq also submh 6TI copy of this fotm v tlthn 30 days of
rah.lltxinfbetian tYlee: Amouat: eamplMion of,veil conv+traian to the comity'heahh dapanmatt of the enutttY
where coftxtrracted.
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