GW1-2021-00380_Well Construction - GW1_20211228

• wfSr�y '
REsMENML WELL CONSTRIICTION RECORD
_- Nadh Cambia Dvmftmca aEmvkQumcM mmdNem m'Res u=s-DWison of War QuW ft
WELL CONTRACTOR CUUMCATION# 2-6 'y 2L
1.WpL©OpiiR1lGTCM d. U POFCAMGS._. ____FF AbomLwdSwbW
_ r� _ �ap of easing<r meted oW below land sUMM aray
Jjk PA ://;n , � aftrosln w 15ANCACZC.01i8. 11
Well ConhacfDr( 1 e.YIELD f 9Pm); —MEM0D OF TEST ;r �D T�
.../ Ian r .'_ I C.�. RG. D I G([oN:'np@ d%/� A160Unt c�Ct�S
c
03
Wei ConUadw Cbmpany Name S. wATM�(ES(depth):
STREET ADDRESS �-r es t F�' _To From To
c:ry i� h i'1 L o27U�1.7 Frort, To --TO —
tSty rTown Sj zip Code Fmm _To Flom a To
nw
7. cas�l�. Dean
2.wr�-LL �toN- _ � Q—Tom.'�Ft f,--�- jD 2 I I Plas
STM WBJ-W" From --TO-- ----
WFa.L c�oNSTRUCRnN pg� tle� "�twP�-► Gj_- From To Ft,-
OTi'IERASSWAAMMPERMITAW 8. GRW1i: Depm �4!
Medrad
s.WELL1lSE(�APP�BmQmwft"� Tom_F- PaA� RAMONO Fmm is w
OgIBIO (MUM) D r•-ti e Ffom To --
2- (f - �.l TO �
DATE DRILLED From
TIME C01>�LETED �'0�� - A� 5. SGREE�1: >� D" Swam Material
4.WELL LOCATION: �_TO ur. In.
CRY: /.�' OOUIV7Y oc��� r+'1 From
GL i S D 11 -- �
Ftom To FL --AL
`�e� PD Ld Ns. Z�L�od� 1a SAMDMMVEL PAM
TopoGRApHCILAND SETiuI 080 Stm ltiAa a1
llS&Opeo ValLy)Ir Flat O RkNp 0 Omer �r To
(dePPoa bm3 a hdaj be m dspAe�s. Frnrn To rw-
LATRUDE c o2 �.- ys .st mft or From To Fl -—
o s/ l� in a dmimal format
LONG-num �O-Zg 11.DRIl!M LOG
Q'S p Topographic map To °n D
(Ibcoun orweg must trowrr s on a USGS ftm nW and -- 1
affachedlo Oftfmm WnOtrrdV.GPS) . -1 �•v r`r 6� S
e IDt.o7 S G
s.FACiLM-isma melmanusimn.reremaudisacm. 3x- ZOO
FACw YMDiW
NAME OF FACILITY _
STREErADDRESS��
EC 2 Q -
v
Cfly orTawn Slaffi Zip Code
r 'e'er•`
CONfAGT'pERSOI'1 2 n M=s( G a a -_
MAWNGADDRESS �aL 9 e ftit�s aQ. -
2 L a 7 p zs 12.RMMRM
CUt orTown State Mo Code
(3!)& } -T&/ - &3 (o —
Area coda- Phone mmrber
SrNIQAEiD 5.AND71111TAGOPIf°F71oS
PREN!MTOTHE
�. TaraL Dril: 3 b REs�ormrr�s
a. DOES W LL REPLACE EX15MO WELL? YESO 1400 � VW L DATE
o.WATER LEVEL Below T of Cas W- Fr / -
(lise'+'if Above Top of Camel •pMtffM NAME OF I CON.S7RUC7II3G'ItE1NBL
I
t the the Diltia�V699-1617 Phone 16),
���5� fit'SM ��it
161T NO Service
i