GW1--05015_Well Construction - GW1_20230807

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CONSTRUCTION RECORD LGW-1 �Pl 9
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watm.Son*Well: 17.f EN ` atATcafA[
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a DateWell(s)Coo eel: 7/2 5/25 well Iowa 95 & 5 EL r_AA. '
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5a.weIILocation: ft. 1
Blair IDd(itro0la) It•
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3�7r, 111o(4S7_ ft. ft. AUG 0 ',I 2013
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scwnds or decimal degrecs: 22.Certification:5b.Latitude and longitude 1a detjtmb�slmtirsf
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6iptma oft:edifiedWan aatr�r
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6.�Dre)the waU{f)Permanent or DTI By ,N lhlt foxes.I Imlay writ dart(kgrreU(r)was A G accoaccordancedm�
,/ rrLb ISA NCAC OICA100 ar IJANCSiC 02C•OaQO Ilse C°ubaar'°°�a��*°��a
7 of tlllf.repairte an misting wens !' °r alb the rwrrragttla copy OW record Am baa',m aid m t ma outw-
fflbb/rn rgP�l old IMIII Ma `i4" or additional weGr�iri2l reanr(a'semfaeam rlsback 23.SiCg& �pag well sit:details or well
Yonoonstrt may nee the haolcYan Df this pane providead
LFar Geopr'o1�n,or Clsaet>•I.00P Gotham'wenshiving the saran cim may, maydso atl�aeL ditioaalrn fns�9•
eanstrn on,only I GW 1 is needed. Indicate TOTAL NUMBER.ofwens EXPEUEAWISMMilt
t:) zq.For A9 weDr. Submit this within 30 days of completion of well
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ca�an�afD the following:
weug UV ddeptla M ( -3 2 ' mil n Processing IItrLG
y p (�) , D�fvialonofWdae Resources,Inforasfitio
It Static widerle.el below MP of adaV 1A7IVIalI Semite Center,Rsldlh+PNCZT699-Sbt7
rivarta leveler about=do're"+ b.IfflikantlYalr In addition m sending the Earn to the address la 24a
Borehole (�•) aabbove,also submit one copy of this form within 30 days of mmpletsan of well
b k- c13113bichonto the Wiwi* .
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aterasSa�ies DIderg xcZ7�-1
FOR WATI131 SLY WELLS ONLY the fo>m to
of
•r ?Ac.Fat wow oya _- Iulractlmt�Weform then
days of
13a.Yield WI* S� Method ai tar: the nddtess{a) �the county orb depart of copy of tius the count
y
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13p,Illsitufet�lon type; �' whose
Revised 2.22..o016
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