GW1-2021-04020_Well Construction - GW1_20210823

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CISubMilence Control
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rqwrfill awribifilto Iva COATIMIllon lAnI1,11-(171ho well ftwer
Ow.-f—der Alt rffln*,TMfft ariville hao-fifthiNfaml. « 9ifcd"irm or vultillitloW wall 001b,
8-ror Geoprobt/ovT or Camel-Loup Geolhermitt Wells havfkq shesme 1,,*tl may use the bmlt of this JM29 to p;mvide addhional well she Malk cor—.11
1—.9"Imlian.nniv I 0W.1 is needed. r"djolo VTPAL NUMBER nf%vrlls You nm silo Mlisch additional puM Ifammary,
drilled:---, " --a SMUGIALURUMMIM
Tn"i welt 2#n.Ar ALW SUlIfflit 111114 114110 W16fin 30 djrjn of MM11WOn Of%veil
RIP n[fiffiFIr Wjj,Jig"JI&Ifff,
rommilins to the follovdaff.,
10.8416'"Waterlevtl bftw top of rasing: (0 D (ft.) Divhlao of Water Pwotsrem Infairmadon Pniceaft Unit.
VAV 1617 hisiff Sw4ke Center,Ikld9kNC27W-1619
LP, llv ?4h,For Igivedge WAW W addition Ito,wnding tlpe form 19 the Attilr"In 20
sdiovc�also submit one copy of this f0fin IvIchin 30 ftys of complewmin or well
C0119111`11111101k m1fted- 1
construction to the failovAnir I
Division of Water Woura-h Unde I rground Irdectlan Crintiral ftogrilm.
WATrR SI.PPIV WRIJA ONLY- 1636 D4ckfl SairvArA Cann RAIeVP4 WC 7.7699-1636
Virld(ADM)
"kew of lest.. Ile r Whiter 5111111111111,&faka con W-d In Adtfilion tosading The flu in
lite aftnvit(cs) abow, aho submit one coPY 4f ft fatal vdibirs 30 siv of
DAInfeerkm type- completion of 1"M cosuisuction to 00'(;OR*I6111111*0111IFFMill Of the GDOTITY
where atnstrtrutld.
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