GW1-2023-01252_Well Construction - GW1_20230127

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mprn�e/Nt'F or flarttdl.LDnp Geotiereal Wells having the snare I Ou MY use the back of this pp m provide t3ddit MW welt Aqa dtdaitt ar well
Amnintctilm,only1 GW.I isnxdcd IlltkcetuTOTALNUMBERafwcILC caul9tructiotldclails. Yaumayalaadlpwhaddttlairai
Balled: pages fi'ntxxssery.
x8lat SfJ11Mt7TwL to R i 1.�wMl itcptk Now land AWf'ace:
+I�&re rr ler�wate-3�0=j�,;jjW)----miSuhmit this Atom With n 30 d cans"Won�lowft;, ayS of completion of welt
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Fnrfwtcetinw Wes: to additiau to NaUft�lZ Well is usttvd(an tttetiad: i t )I(� �1� Wmve Aw aubmii one copyof dris form 30�days�o mejp addep f e n
•�m.�[> .etc,1 —""'^^^---- eonstntetion to the followinpr platlDtr of welt
FOR WA 1�R SUPPL WELLS oNLY: Division of Water Reaaurcay.11ndergrarnd l�attoa Coutrv)progratpa
131L Yield to CAS. ifi36 MAIL S Ccwtar,
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rib.otsiwfecthM ty ' �' In mmalon to sanding the Rmm to
the addresses) abaves: trim submit one cone of INS bM wltlilu 30 days of
AarnurD CO M IC"an of sttrctedC i conamctmn to the comttp hoalth dEpatOneat Of the ctwnty
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