GW1--00521_Well Construction - GW1_20240118

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WELL CONSTRUCTION,s�'wCOL D t_ - — t
t for Internal Use ONLY:
a•ns Conti em G used for singlen multiple walls i
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i.Weil Contractor information: - 1
Rex Meadows 01ws r14.WAX&ZONES
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Well Contractor Name 1 .- � -_ _r__. _ -_
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NC Well CantractorCertification Number I IS.OUTER CAS=NC(for niiltl-enseit wells)ateL__a R(tfji!u eblcj_M!
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Sb.Latitude and Longitude in degrees/minutes/seconds or decimal degrees: a�''J
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6.Is(arc)the we a): '`fr;'n aertt or ❑'3 eutro=at7 Sy signing this form.)hereby cerl r that the nell(s)to (were)constructed in accordance
'eat:lad titCWC.U1thtl or:ad A'C:t.,?2C.,t'e'J till Castracore,Standards and:ha:a
7.Is this repair to ass existing.well: Ores or y.i"+ cawo - c, ofdJsrecord has beet urcwidcd to the vie floater.
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repair ruder f121 r.-i crb scein,n ar ear the back of this flirt:. 23_Site diagram or additional well details:
You may use the back of this page to protfide a.ditional well site details or well
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o_-swim?wos Amp,ncin..•"trmo rstrtecr: _ _ _ -,- - -Fri 24a. Tsar All Wells: Submit this forts•..-ithin 30 days of completion of wall
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