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GW1-2022-09996_Well Construction - GW1_20221104
�v� r nt RFCCA-S G]r{r t t TJ ➢ ,, J/]IiI r k t Su t GNcryC llvt4tY4... _ L'tdWaUi.o t 'Clf:p:5) ii��f 0 rr1- f I .ors _ _ ^tin ,.gal r_`Y -nc a+ J n^r SupfW is r36_) L �tLti anon rc s _ I "'waterUI rl :SupP[Y(hoxoi) ytl Ply 1!'elh m GRouf- ., MJnitonng O't Ta +rnt um }= ff�� 4qut`L:R0.hTrge f_}Aqu+fer Story ©Go'r d,.+'f Furred ioticn fc kRu1fCrZ'pL Ltnllry�aRr r. 195\YD/GILtVEI:P,\ L hl•) - FF—�-tf (— F'Ol CO M1UTi VIAL 4--d��A-'�mcntal7 CcFmofogy C,a[i:ert+iat }Sub dcncc Cantrot(C/oscxl Loop) p-y is ec Geethanual L1Trz r. FlrvHapJCooLng R^tutn)D.t,Well 2CaRtLLIIiG lfH' itm:Eadd.po it aUc ti o-+-•(=3�lau+unticr i/21 R�na:.ti;) eao:rt zo I n�scFueno� �.r --G� _ _ (s)Complzfed: x 2 ft- tea.well Lo �__—_ ) p i+ y/ F oS=J`�'(iFapoli�blo) ft. to ' PbY lAddrtr C Y dZ 7i F / C Z ids d ft. ft. - � _ af:n�rertits r�ti�ira•rswwnoallo (peas __ — — - C'f eU E Lt/ltude and longitude la degrees/oiiuute;fsceoods or decimal degrees: (if.vcll old,occ jovg is sut$sL;ct) - 22.Certificatian: 5.s(are)thc wrtlfs)�perctnBeat or U.Cetnporary SI uc oFC '6ni Wel(Cor - - Ir 7.IS then a repair to an evs Eng Well: Yes or % _ `ay sryNd�t6(,j, iF rcSy �,f ser6t_, I)r Tro t Ln ISif 71GiCU OIGU o, 1 A C+t�o2C Jr J I �,.; JGis Ls a rc a(r,fill oU!watm weL'eorstruclfort brformanac and_z,lain tha nnrtu�of sa 17 f - co ofGLirccard�.E.utpu d_1fo Gz rcpavurdcr it7l rem.,ari5setfian ororstircbadc of[bi:fcrm. �� � ' 23.Sit,diagram or additional well detach 8.ror(':eoprube/DPT.or Closed-Loop Geothernial wells having tl, same You may use the back of Us page to orovid dti ti, i i i-ash-nefion,only) CiW-( is Headed. Indicate TOTAL NUC,MEP,ofweth comtruclioudctaiU. you may ado ally ha3dt}o ;aa o t driltcd: _:: _- SUB"TTTAL I 'S1 RITC11ONS 1'0t-A bell depth betowJend surfaces ,5 - Fir J;l/�I-wells lGf allC 1fu! dr ercnt ,...om Ic- ) 7u. For Aff Welly: SnEmft 1F+i;:fnrm risia 7U e Is t ec,ra p f .� C"' P �uusmrdlptoa) _ coashuctiott2o dlc follovring: W.Stadc platerleyet helow top of casing:. 3 - ,f»star love!Lr above e Iag,use "+" (tt) Division nt\Vata Ztesottrc:3,lnforina&a t c.».:=J,P� - - 1617 Bfaile t\t Mutt ,Itatet t;.1C 7? °7 5 '1.Borahofe3iametert_____�_(in.) 2dh.For IntectioaWeli,. Ivaldtdant>e_:Sai3+ �� ,.,t :z ,- above, also submit oqe copy oZ,ZhiS fof i v,Dk4c t. heft c:co; „ .. 12. construction method: �D / n constmcGo❑to the following: 'E,auk,mta.y,cable,dirrctpnsls.UC) r Division of Water Resource;,ULd i,cotmdJ ) a?1 . P, , r FONVATERSUPPL7Y}YELLS ONLY: . - / 1636MailServlce.C.ut_„P�F:Igc,.,,,Z,..'s., 13a_Vield(gpm) > Method of te5t: :-/ lr 7L _ 24c.For Water Stipoiv 81 In ec6po WO;-,, a s qq the addrass(cr) abovq also submit o c n t I3b.DCs�fection ype /, / Amount: J r comple oe of WC11 ccasu_L_,- wEeLaConsti ctr