HomeMy WebLinkAboutGW1-2021-02624_Well Construction - GW1_20210923 WELL ONMITMON RECOR
Tbn has"a to vart jorsaigie,f4 awhsle INV, I*10VISI Use ONLY.
1,Wit CmVot:o:r:s(*,%ivis r.
,J7� rr!j
Was-$Moww W."
K Wall cowsc.—CIMUS.S.NuftAn
iftpk' .
HUI
1_16
L Well COOOM46%Parmil 0:
Wt 41(FOUNWO MN
2.We"1""
P.SCILBSIX
IMAIMINTICA I 6IAQTUU FT�
It. ft
("4411W)oolml 3WP)y) iLrsrderris,'41",%4qy(5i**) Or. h. 1 , hL
E
w#!cl sue) L ILGROUr
i MA72RUL SUPIAMMPT
I'JIRi ton
Me*-Wskr bap.-Aw wig,
7 i% IL
IL IAhOfG"V9L PACK(Ifamitivabia)
CA4%AF Skwap and P-..vyvvry Use1wry Darri.; -.7 AINK11MIS
A. ft i
OL
CaxpWvtoalid TsOvawsy
OSVAW'A4rK*costrut
(Closod Lrxq:) Ci 7 ravw
—00kOwntal(W4411nolcyglum RSCUMl' Maw ("vion)k;X-Jlr 021 MAMWAIS) "t OL
Dais w4wo)()6myto"A: 2 a,
k (
$6.Well CIWP -s;z4dL C-5 ro
k
F— it. to
pacoir'ownw Nam* Facility
M"M&t Aft,60S.Cyy,M4 Zip X
'it—ABUM 4;41
ft LaIiistis&64 Lsagit*dt in or tistimal dweat;
([well dell*at IKAOM is sursvica) U,Cortl 3tion:
W
lr(are)the 0914I)a AwMAINst or OTIMPorem!
Is tttq a TtPir to as eabbas Wag: Oves or
2).Site diagram or seltilliossl well delaft
You:USY Ust Vie back of 11iis Page so FMVW*s"Ifivial WOU 0'.4 4"15 or-cf,
c-"%ALVvA4K&)l.
-4**vW10-69-7-r—.10,At S"W c—%PWAOw you Owf
MOCTI-AL IRSTIAMORS
91.Tiaal wtV gapilt bdow load si,rfaet:
(ftT 34L Fir All Wells; swwsit 1h:s MMI wtviul U 'Uys fwMPIsitin of V;%
I'M AWU##-Pkf Usl off AOP (("AO -#As fr'vw'. Iwao*0R4;qdtw) corut.-vAian it:the(allowing
9.State Water level Imtew top of CAA;ag. Orviseas ofWswr Quyliq.1fdormossion Prucessias Vois.
1617 Mad Service C-sUW'141141i'Mc 114WI'M
_Weft. in addition to M141"It*J%*fw"to 160 64410AS hP:4%
LI,Wag cosaroctift aft.— 'Awe A. .erg,' of .'s )1. '% V woo days of a�rnrkion of wC11
a.matt.easy,allele, no c,.# figlowb%
&!*..
FM WATM VILIPPLY WZLLR OM.y: 16X MOO Sirvica CM143F.R811014k MC 376M14%
13a.Ykfd L-C 24c,Lz-wcqrsww fdt r r ttisr.WelkeJ1141ition to twine the rum 10
" oftails(os) above, also submit o-w copy of chit farm within )G days of
ISUDial"WON OW:ChLarih4P Anocuitt; cor"plation of well tonamfution to Ow courtly hcalsit depaistuant(41,1W
wlwg tormrwipa.