GW1-2023-01117_Well Construction - GW1_20230126

UCT4QIV RECORD
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?Ab.For W dtea Wei: to addition to,'seudmg tho f'M to the address in 24a
12.Well omtrtraeOM M40 above elan submit a copy of this forth within 30 deys of cm*k m of well
f.e.after,tau O �l`:VV cottetcuuMn to the fbllowiog
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Dtvlalett at Water QtatlHy,Uniet Dalttai
FOR WATL+R SUPPLY WEl1♦tt ONLY: 1636 iVIta1N Sewtoe CetMar�RI tkl�,NC 27bMrtM�m
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uhtet�„t the tttidrt at(t v)shove, also Blbnit Gne Pcopy of utis faun VIM-W dM of
Amount.- complexion of wdl eantxtu ft to ft itotinty hiahh dttpelMM of the txtlitity
vtttene consttuctea.
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