GW1-2022-06981_Well Construction - GW1_20220725

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.71otTtavofldeptAt>clmvinndSprJMcp: (tX•T � , a'�r s J�a Submit thhl 1brM whIlin 30 days of completion of vvcl!
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1 i.ROMItaledlametcr, of this form within 30 days Of complcdltm of Well
ahnvc,tM submtt one ropy
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(i c.anger,wtnry.ca$k,Orcct(kaeit,cta.) l)lvisian ofWaftr Reeo mes.Underground Injection COMM)Program,
gall WATFRSIL?PLV WEi,IS ONLY:
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[3a.Yicld(�PM) _ tlla ailcimsx(cs) abitvtL also suhlnn and copy of this form within 30 days nF
Atrtotmt: mmptction of,vdl corbuncdon to the county health ilcpluunent of the county
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