GW1-2023-01251_Well Construction - GW1_20230127

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dcijle retian,onty I GW.I is needed. fndkft TOTAL NUMBER of weds Construction details. YOU may SIM IMMh addidoml ifs
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d�stlt below land autfitcc:1 a�rrerk�pf�weNa/r«atiaepr&'1r4 rrWr furwMC-3@200'ma:Eptaa) 241a• Or AH MW Submit this iham within 30 days of compledc a,'orweil
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FOR WATER f,[,PP1.V WEL&S ONLY: Dht/slOn OfWater ReaotpaeR,lJudcrgt chair!igleettoa{btttral Program.
1X Weld 1636 MARServloe C--ma RakWh,WC2769961636
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tab.Didufcetion type; Amours the address(es) abnver al" suhmlt one copy Of 949 form wilhin 30 days of
comptethon of"vdi construetioo t the comity hwdth daptan mm or the aaanty
wbere cmtsttreied.
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