GW1-2022-09673_Well Construction - GW1_20221027

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mi{WATTR f+CPP?Y WFi�t�9 ONLY: Division ofWater Rrsour min Underglround injection Contra)Program,
1636 Mail S4rvloe{,`ante•,Raleigh.MC 296ry99.1636
)3a,Vtcf d(Rota) Nethtu(of tc4l: 2tes ,tor VVater_S@rnMv&bleu8on l ig; in addition In sanding the lbmf to
13h.1)tsinfeenon type: the fiddw.mCes) ahava, RIM Suhmil nee copy of lhig feint within 31)days nP
Amount_ COmpictinn of a961 constn=dOn to the cntmtiy bate th elepPMcnI of IdP county
afhnra ontt9tfuctod.
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Date: -
Well Case: Welw L l 00 4 t
Name:
Address:
DIP COjv-C-eet(,
Pump has been installed, well head ready for Inspection.
Sign