GW1-2021-04194_Well Construction - GW1_20210401

y I 111M Q;Q -
a t5l Ielt+rensl deb®lily: f
'V 1.well Coa titdoa Rdomuldoli:
11Ve11 CotKre W Name
m>ae
° °"leis a •• �O
KC>!!r3l-MwwConhez�rt7eiY�es{ioaiVumbsr
'PtRRCESt M
r name .9�� G.
�$�f
MU�ae�eflion�iirmR:K• W?_O-
moon Iva tj I� 89.
emlal(Heatie*V;ool ayeP t+�.l�unioiPel/Preoblic
➢ttdnatrl PIy) WRosidential WSW Supp)y(fi(.) ta.
""'„`-•�w�➢8i �I��/3Q�i�l�9RP.P�pftfl�tr/a�ararRl �� �° � {f�,
1tdi: To 7tRRRAA. ----��
a ARoni ° rl�rtt�fl4 Pour
Rom MGRoundwater Remedideion 9L
uifer Storage;, 15881i liev Barrier
f `�*.'gianw•�6n{, FAtlR4 ;tt � a -
Gcodwm
al(Closed loop) bs➢dence Control B&
Geothanlal
WnUaft02i ReRnaelss c+tso�H
4.naft'veil(8)CdAPRcdada 2._oZ( wen MM. 8
sta. ^Jail 188Bom: �Z . j)-O 6yk
�► �Q 5
t%eE+t in,y/Oainter i�uee: �
12
Foay{ty Spy(tgeL�li�l®)
40
ftieal a4Y:and ZiP 'v17:S14 R• W
tLoeiemeBea®d longouge in 0l3utW
(ifVMll field,one labb i® cte�R) ado 0��¢s{� �, ,
Zz .,�:,t,a
®.as(aaoi Ht:e watt(®) l e or u' empoa ,
3' ®g .._ ell t�mttcrer
9 IIO�� '®0P t)�e
UKrlx ta p palr, I t o SENDS we: 3yeo or [ No IY+► ,lhld jbm I hardy&MIfp Thar the ware]ryas{E�eae)oolretruded to aaxsordrdree tupalrtomer#2I v'ar Mwi wkH Lvbmtmlon and erplaln the Ron"ojtlr_ �PY�Ihla�it�aoAdh�Hess �I fA NCAG'0?C..O2UD L'✓eVf C.oesrndlae dartfs egad Kra!m
serx►noeoranthe olhtsfbrny ProWhAtoKraQ;-1w.
&Laor Qoeo Z.sib diamm oft addidond wa ftaw:
l t tt is �p Gamemd wens having She sme �tou MEW
use the bach off d i,,pW igo .. /0 1.y
'—"IY Yc6 m46 y'.'L7—t�,'•.rvr�additional W671 t.�W
orulcn detaels or w@11
__._.-.
�.'i'otm➢WA&we below lased am*":
ha?inulKple Welk HSIdl,' Ud(i �,) �
tam fe ,ple.s�ph�arrda©loaq " Submit this force vritlein 30
H0.sonde Water ibelac cap of �3 00elstRustion to�fbilovring days of completion of Rv€11
Uwatarlaeellaaibous peg"�•" (&�)
. IDlvlDloea o4C"Jmflerr o ,FmLfir�tioea Pmewslas Qlnk
y .e _---- -.�".=- pbee j flAfl9 RttaiB�etrerl�Q°uawtc�a.fitei 'a eb !qc-wen 99117
02.weoi, �4�Atnrr if�alerae..,�oty„m�.
out; g �1� a in addition to sending the fi mu to 0w Oft=•m 2za
({�+.aqs,who.cords.dhbOt Pam.ate.) �� 0 submit one of this form witllte 30 days Of 6ontple2ion of t^mil➢
00naftelion to the fonosv 4
PM V"IA Sll1FL5Y WILL-ONLY. BDie isio®of Water%
ISO.Via(M) 2 Il��FJdt g Me Ce® Matl[i ,IqC aoe�etrd�9 fib,pp,
I'Jli cued of t�All•Romyg� a i`JC 8t
29e. s s avrroPr 4`x:saRa f^
fl38a.IDlsgeef¢etioa[ l�i�i __ r`......::c:.:.....
_ Aenorant: ��Z the addrassigs) above, also submiit ions .....
-vfg*n of sell 00tt foa 4 tlee tom, f0nn vriBhin 30 days of
Foam mW-1 t� �tenceed. eR�t of the county
SNosa6�ltne l"tment oflinviemtcl ",{ty-ptvw"of wrier tteae .