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HomeMy WebLinkAboutGW1-2022-09666_Well Construction - GW1_20221027 828.622 72+41 p.1 f=ot>16 4005;43p Cleannraier Weil Rrilling ;,;;,�,.,,,r,.,;..�--• WL 01'd�'rRII T)G�N RECC�uIa 4GW-Il r For Internal se nly: It C.netraetar lnformatian: -�---- —" t ZO ES pg9Cat T - SVrI!C.rntoacttx Name _ ---------- �ltvr, cdren. ae Its >t�G Well C.nn�got�atificnrrnn�1+:m1:nr n I ( Q t M $R TO pry/ 7U ffi3 MAtCnrAr t_16.INNER C iIYG Ott�'11 diprwl (.:e;npnnyNamn 1 T� C NAtti'NAL h 'I�iJU✓� hu 7..}Yeti Construction Permit ri: � J �----�*^ ft. it. (dst rr(t igr/,l(rnhfa+va11 cnncntrar(nn purm!/r�La 1111~CanNy.Sa)!�YarUrnca e(r J i� 4 — 3.Wdi ifir(check well nse): _I� N o� sMMrut tits AT ur. �Vlitcr6npp(y�Vcil: -"oTvi ra � Agrictdttual Munielpamblic Q o- o- Geothermal(1;eaNn(g/ConBrtg Supply) R,sidcndal}Valet Supph_•(01191) it, ti. io. [ndastriaUCnmtnarciai Residential Water supply(shared) e>�a M lab w t)Nr .rp MA IL N. �tnlcrSupplyVlalt: it A4onitariag it�oven �_ lnjcclion cil: ft. R• :, Aguifa TU,4la%r_ O()roundwntCrltcalediltinn IA SAN VR pAC t ilei t t, (n M atrl►tan Aguif:•r Storage and Recovcrg OSntinity 13anier 7leluitcrTrst r]SmnnWAtcrDroinagc Laperiarenrai�'celurningy Subsidence Control tat. it. C,cotbermal(Closed Loop) DTM.CT za Rrt.L 4 ■� . .K M � Cicolltmua►(Heatin Coa{in Rctum) Qltler ex '4S ude nr tl21 Remarks) �e ir. 4,nam.NVeM(s)Completed-.;-- —� �all ,SO WciI Umflon.. l sgiit�s+i)anar}lame Facility[no(ifMPlIcablc) >r. b,,.[Addr..,CIT,and Zi uff _ _ Car+mp k'ared Fdantilirattan Na.{Pl�tl Info an Pmcw rwj l.lrtbS 51).l.OW&and MnAIN&in deLtrmdmllu►tesfsecandt;ordecimal degrea.' (it wet!riald.one Monginsutiicicni) a 1 i:e 4ationq r�trr aNirY tidnnlureefC.�1(GedWeriCoud'aaror � �` is{arc)the wails) Pcrmanerte os' �.,r��n emwnw cd m acsnMnucc �,.er(mrnR rNt�.trn,f Bcxly rmrr[j:rhnr thedl(eJ am him lallrisarcpairmancxwtingwen: 'es or YpaZr.dl0Dnr1SANGACO2f,.r11aDWrltCom+rnrrlm►57amiarrl'pa,(ehm.r /ffhevfe:7rcpn(a((1/Prrt�'nalt7Jtw+fi,la,srr7WAA►llrarm 600 and rsprOtrr7hcunruregr'Jhn Cnnl+nfilrlc hM.11(+Olt7+[•C+)�)mldWin1ALlv ell nuft% 0-17111rrmder001mmarAyswimnr^nthahockoffilbjnnn. Z,y� dlpgnrporadMorwl wall didailat R.Mir GeoprobefOPTor Owed-lamp GOOMartnal Wclh bAviag ihr.-tine 1'ou may use tltc back.of this page to provide additional weft site dletnOs or tcrtl mminslnretion,only I GW.I is needed. MclicatuTQTAI.NUMBFR of Nvc11c cr» i°u`irraits You may alm attach additional pagac if in:cessety. dril[nel:^.... ._.....�.-.. - �fe1���A1 lNi►TRtiC'r[t)R1S rak21 wdI1 doptlt below land rurfmc: y (R�) 2qA. Cot a. ii WAIA: %bmh this'facet)within 20 dais of comple)ion Of%%til ImrrNnlffplcMrDriitralidrp)i,cJifrjr¢rrnr(rsn/rrp/e-3[n�3pfl'Qndc�e}[OP1 ) cones. i ion in therallalVtng; In.Statiie waterh:vel bclaw tole of casing: (11:} Division of Water Retiaurrees.lnformation Prrrcessig�Uidt, Ire'nlCrrincl(srrhrMcwc/Ag.rne�"•/� / 1611TA'l4s'w4kcCcuter',ftedgh+14C276"-1617 t9.Itnrchoiedlameter. �` —(;^) yth BE Injection♦Yells: Ai addition to vending the fnap 14 rltg O"ffts in 24a ai)9ve,also submit one cow of this form within A day.q of complatlotr of waII Ix.Welt cnnatrrletlag method: r O elva action to the f13116VAng 0 c.Mgr•,miry.0".olrat pltsit,etc.} Division ofWater ltreinirmi.Undergrannd tlndtxt#on Caa1ti11 Program, tY3RWATRRIS PPLVVVE,LLSON1,Y: ifi36 Mail Sm'VICeCenter,Ratc)$M,AICM94Ql6 13R.Yield(QpGt) L � _ Meth1)d te3L•2 1,01 zw.r' r Waicr Roaolc&is man Wells: litaddition to swuling the Ferro to the gddrrss(es) above also submit one ropy of tbls fbim WIND 30 deys of rib.p►sinfectton Amount comptction of well constn;cdon to,the county health depariinenl of the coutrt}• OTC - - "hole ewlMeted. FOMI Ow.l Nonh[.meii+mDarmmaent of r?n ininmeneil Qun111y-0M.-unn of Wmet Raaumces ReuiaeA 2 22 2a1 t Date: `30 Well Case: Well#: O C - (D()C) Name: Address:'F U O-� ' Lti , t�G Pump has been installed, well head ready for inspection. Sign: I :