GW1-2021-03598_Well Construction - GW1_20210823

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M_Site dia6rwn or additlanol wall deaths*
8.For GeoprohefiWror.Cursed-Lapp Geotharma)Wells having the cawte Yeu may use rile bitek of thk page to pmvtdo addifiaM well site daleils or well
MwArvirtion,anit I GW i it:needed f tow TMAI-NUMBER of,.xiis cixtativctinn tretails. You May alo altamh additional pugea if nnmat W.
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P.Total•well gc1i 1141Aw land sprlkec: _(lt:) g,Sit, )for_All_W-_e11s; SSuhmit this form wits in 30 da39 of eomplmion or vnu
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241%flnr t.larrion Wetly to atidition to ongung the form to die addim in 24a
12 Well coalatraetion melhadt above,also submit one copy of this fmm within 30 days of eomplrado"of well
(i c.m,acr,meaty,vabk,tlirct.K push,etc,) eomfkttetirm to the faIfolvirc
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R WATER f+UPP V WEL.L3 ONLY- Flivtsion of Water Rtmmreet.Underground Itjeetton Control PrWam,
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A.t)lrinfectlan tyi,c; thn udd[4ss(es) abnvq also submit one espy'of ihls form addlin 30 days nF
�ruoemr �teptdion of.vdl consuuexioo iA the eq,mty hawth A pattmem of the county
where twrt9trrereid.
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