GW1-2022-02998_Well Construction - GW1_20220228

ip�) ✓ q / q - y-75 " 6
3YELL CONSTRUCTION RECORD(GW—= 1 For Intmol U§@ y � ,
�,— � a o
I:Well Contractor Information;
e� Her b t
WeltCenuaer. ame / fF fF g Unii
n ,.
IBC We C-ennaetor Levi on?Jambes ^ 15.PUTERa i PIN IKUNERMS10 licabig)
`� ft fE: In:
V64anY idame E R TAING(mmthprw al flosed=lopp)
9,W@ll Fon§tr oon P@rmit#;
l tot Of opplieahle¢,ell renstrwetian perirrds t:e:Vi , a!f Mate, urluw—ete:, fF. fN In:
3:Well V§@(check wrll u§@); fF f6 In:
at@r:apply W@11; t ' E
UAgrtculteral UMentetpaftbltc ft< f6 !n:
09@oth@rma1(I=I@ ilinWCooling fiupplY) @§id@ntia!Water gepply Oink) Ik � !n:
Ulndu§tnal!Cemm@r@i@l UK@§id@nfial Water kipply(§har@d) 1 . um
Ellrrig4fion Elw@1153
NwWnt@r•Nupply Well%
UMonitoring 0R@eev@rY
on W@111
UApeif@r il@@harg@ Mroundwater K@m@diation PIAIUK fifaPplicable)
UAQuif@r gtorag@ and l€@covery Ugalinilr barrier
UAtlui*T@sI PROrmwaterArainape Al ixfF fF
P94p@rim@mat T@@hnelogv Ugeh§id@1w Control fF f;:
U9@@Ih@rmal(Clowd Loop) UTro@@r attach y44itiopol she--is n
UB@othermal(H@atingiCooling Kew m. ) L:]M@r(@. lain end@r#?i
4:Dot@ W@11(§)Compl@t@d; W@ll 171#
1S 7�1`l ft- fE: _e
Fa@iIjIyi nZip Faei 4 IA#(if ap hRbl@) fF ft:
— ft ft b
Phy�_a EI 55,city,Ad&P rft ft
� t'(25GiJ 3 .
REMAJW
CnnntY PWei Idenpfi@atien No:(Pii,)
Ah:Lotitud@ and longitude in degree§lminmt@§/§econd§or Mimal d@gr+@§t
(if well field,on@ larneng is wfliimin) �:!ertificapon;
?� W
UP@rman@nt OF T@mperarr 1gMatwe Pf P@Mtl@de onnew pille
flv signing this form,I herehx w1ijv that the wM(sa mar(were)egimowwd in ueeurrlunea Irish
9:i§thi§a repair to an @§i§ting well; Y@§ or ®No I N�A�9yF:9l AA or l34 NSF A#F:A�99 Well Fansrr�rctien Ntandur�ls and shut u cepx
Lfihi$is o repu!r,fill utrt known well rmtstrrrrti injarmulinn anAerpluin the nanrre of
the uJrhis record how Peenpruy!ded to the well owner:
rep9n,nodes#�I romans serhon or on the back oflhts f r!n i J.bit@ diagram of additional w@II detail;
fi:For CAvpreh@Il4PT or Clowd=]Loop 9@9114@rmal W@l1§having the sarn@ You may u§@ th@ boor of N§gag@ to provid@ additional w@ll conAwfion info
eon§Iruction,only i 6W=1 i§n@ed@d: indicat@ TOTAL?3Ulvlbblt of w@ll§ (add`g@@ 9v@O in Itemarit§bolt):You mar*9 attach additional gag@§if nee¢§§ary:
0114 34.S"WWAL IAik9`HUtL'I'ONN
9.Total well depth below land§urfac@; �105,
(k) huhmit this GW=1 within J19 der§of well eempl@lion peF th@ following;
For mnitiple wells Its;ell depths If40reni(¢:rump e 4 _AA ,an//_,_IBA,
19:5IaNc wow-i@v@!Mow to of ca§in ; 7� (�) 94a: For All WeAst Qriginal form to Pivi§ion of Wow b@§curve§ (AWR),
ff worer level is obey¢rowing,ime"�" g lnformatMo ng O I,1617 we,ilal@igh,IBC 29699=1619
11,bor@hol@ dlam@ter; 1 (in:) 94h.For lWwtion Well ;Copy to AWII,Cnd@rgroend Inieetion Control QUC)
Pregram,10d a MgC, eigh,NC 396HH=16d6
I I.W@ll construction method;_Lr — �� 94c For wator.Supply nd Onowtoon .Copy to the
(i:@:anger,1ptw,@able,dire@;pwsth PLC:) Mnly errvtronm@nm[WHol 99pffFM1@,11I or me eosin @r@ tn§a
FOR WATER SUPPLY WPLM 9NL-Y; ;
4d:For Water Walls ur{tduelns aver iRR,RRA SPA:Copy to 9WIt,CCNCUA
l Via:Vicki(gpm)— M@thod of tots �- P@rmt gram, @t_ , _ _
13h:Aisinf@etion typ@; Amount.
Form 9W=l FJn!ih Carnti!!a Aepal?m@n;of Fnvir+Inm@n;at Raati;r=i�ivisinn of Water Ressnr@eser.§ed h 6=�Rlti