GW1--03099_Well Construction - GW1_20240522

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Y.Well Contractor Informs km t
David Belcher ��__..__ __ �._. __ _„m
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86 R19ltldaa CASINO®i8�1B➢AN dp e1ttpter!npJt eioted da ft List all opplloablo well oaistrurtlon;emits(le.WC,County,State,Varia,, ate.) EAnit! R. ' T® Pt t 9TRM1B!E8,dn. dNICKNEQg MATERIAL
3.Well tree Eeteelt well ads tin —
Water Supply elpo "'" d oo' 1
Agricaltttral ■ ; woicipaUtublso _ 7 soma
� tM1� a nacre >R s�r size a7tiCKNES MAMMAL
1" geothermal(Heating/CoalingSupply) R. 47, .
pp p) ..Residential WVater Supply(single)
Endlisimal/Connnertual DResidential Water Supply(shared) ¢te.
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Non-Water r - _ nta IIZ aMrewdsnaea�rglartionet�ralumo►er
Mtaaitodng �f p� a,,�E ,,
estlon eft: rove It. L7 (� -r , ��
Aquifer Recharge I
Aquifer Stoma and Remeddatdon a
�Bliplt�)larrier es ;,., 0: tIffi.ITAd:HSSdrepethuirt)
Aquifer Teat
03tconwaterDrainage r _..m.. .erfl �A�Ann.
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Experimental Technology
Geotltannal(Cksed Loop) �Btt6stdenee C©uteoi ft
Geotlhermal los Conan 2If.1nlNLbQ i Unitr�idition Yelkee&I/meceeea►y]
Oliat(cx lein under#21 Remarks) al" DESCvl ire EVRamnmerueetz..waedtiaee uka eo
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Fa Name &WiIty ID*(if(Iglealole) R. Qt
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Pared idutttifioatttm No.(PIN) 1.
di s.latitude and longlbede In d�ees/asitbttterisescls�is or/dlecl mat&gra t .@
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or Dissorma sigrimv,Afcatihm Wen Conttactoa 5 ��'��
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• s Oaa rr ,gy a geir.�this fonie,II liereb,wiry that the,well(&)''ties'{vent*aim k rwsin�Wria � itaotr l_�ll�l:0 IvtthISAerva:MC.019Dor111,1fCACII,1C"AIJUOtyelIConsaeArimit�uftlea
t�'a1 �iaaara ww Icon end=p hi the oalare of dui copy offhlc esa-a,e,hoc hum provided to grit writ ownar.
eria1IMta ,nttfalarkofth►s f6ya7,
I.Yea tJsam l'sr E3.,Ste ir=oradttlirlll_Ng Maas QN� cite timed` ✓ellia having She same Irma may on is bat Grab r poi*additional MI details or well
drilled• ® AL NUMBERdwells coEsrettctdonttlM atl
details. YwsoraafhiaddllIoaalpegp �a secessttry.
4018
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�aall�l♦iaaid fawn tFxampfe-MOD' nti 2(4)10) _" ') $'��' fortmit dda rm with 1♦0 dips ai eotnpletina of Well
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of testrirtrfareitroalsr ■ `Q"""-" /Irk 634'c'
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p*tea . >' v uy-_�_ above, a*SON di*�sB arY f0 day etsmaiBllaa of volt•
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Y3Ye.>Dl e� she adel5sss(aa above, also submit csie copy et t1W rs 111r 30 days tot AliounCI-- G.f..'._;4---.a,____ aanpietion elf welt construction to the;:aunty Wok depoolosa ttt the county