GW1-2022-09843_Well Construction - GW1_20221028

828-622�72�4 P.1
Fob 15 [905:43p ClearwaterWoliDrilling :::.•,�.•
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WELL CONSTRUCTION RFCORD(GW-1) FnrintemnT URM ty:
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herinal(itentidgicenling Supply) Rvsldendai WaierSupply(single) A.
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ation A.
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l.;vnlrHadarh2twmarkcrV7lanorrmthe.hark nflldsf(n>7n. IX,q,[tediammoraddittotmtWait41HOINlr
R.Fro G. robe/Wr or Cuffed-l..on G081111 MI WelTc having the sanir. yall ntlay atse.ilia book of WO Page to ltravido addilioltlal well$Ali retails or tvrll
rxrnsmratinn,only I GW-1 is lauded, lndianta TG'fnl.NUMBER nrNvcuc rnl19tnmfint1 riclails. YOIi Inky Also a1tA h additional pncs if ilm fit}r
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y Tat%,walk depa below land aurfwc�„_ (k.► ay„_ Knr nIt +iyeiFc: Sttlttn$this fond within 3tl daLvs of corrrpiclinn�f wellPlit,iROrIplr.wens liteal;evp►tu-reap'arant(aril i?4nfl 4ir'all(I201001 rnnvimCtrontothe(bllinving:
In.Static water level below to of rasiP ., ._ 00 Division of WAter itew►irem,Inflarmatim Prormiett Ulfil,
r iblTktaR$arvkvi center,UWetgh,l'1C 7AAa-Iorih
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tI_1lnrehatcdismety: /� {lo•) 2'/ll 10 addition to h'e sin&the hrM IP ui¢odour in Zoo
atnvC,> gubm,t one copy of this fovm ivltWn 3n days of comPletltttt Of well
Az Welt cnnitrnellon methods crmattuction to the fallowing;
ri e,mess,mrmr.sable,dh•act pw41,41*
3llvlslon ofWater Rtatg I'Ma Undelgt±annti T> tttlan d:nntnll Ffogram,
VOR WATT stare v wAr.tn9 ONF Y; z rss(►+lair service eat ,r,w;�tt lr;F.l�iv 77091 1636
DR,Yield(gptn) MQthal of t T --_�-�— 7:tc.t+nr L`Ztvr St nl�&Stafeatlen O ff: In addition to sanding the.Rwm lit
The Addresc(es) above, also submit onia copy of Ihts fond wilhin 30 days Af
13b.INSInfeetion type: _ _ ,Amount: completion of well t:ntisutsatl'an fa the,conaly hasith 0cpatttneal of the county
- vrbare conatmctee.
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