GW1--03162_Well Construction - GW1_20240524

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a.Well lilt(cheek well oat)!
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o90tliCntlnl maxim/Gomm& m etutidarnInk Weaor supply(Atnglo) p.
tnoutiallCoflnnitottl aftmitIontIot Water amply(storm) -. t rill
*ft-Wow Supply W J-- .. "^ ,. U its . .9,1Q 41- 'mi LA 4. --_-..
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sown ! y^0'r r""r'"r1°`•'e'aiaar Bra,wrt(.Zf+r a+M1+,a*nxrei i:>acuantlenrr
7.1A tole a repair W an exit* welt Yes or .,trA rs t.rV iC'02r^.'Hay or L A NCACV'r,OND WNH eWV!txr$i'1!tWAN*inn)Ihm.t
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r R r motor A.2f iAJoiler>♦L'1#b'tl WWI SIX Mir/nfrLtx.lirrni• a:S beta dieogreLta or Oiritlwwt M40
4144410*
Vou noes,kuo$Utiw took of Ns pep at gem*salami twit dtta 4114111 or well
R.For GeoprabeRIAT or Cleaed-Limp Geothermal Weill hiwinq Mo Foram: wow tul
ntnt►11 Ltllls, Yon mot oleo aNM1aidlAanitt Rom'tf acocamotry.
1x110411iatitm.Mm11i I CGW,t in medal. intItuRa TOTAL NUM0R nrwetio
orstannaulouguagula
o.roue yin*eseptA!slawIm111t oorIM Las^- J _(Rr.l WO. 1"otti'-.A!! gubrolt ea Jim within 30 days'of cqi p1 lion or well
Pr moketo tprOf tip lli d mo 0'4(A/,W pw mpk--111Ve.anti 41101r) onantr.tion to the Ibilw +B:
in,%tie water ireti Wow top of main;._. .°Li --- _(Pi I1iviiioa of Wow t�1�411 Loa Prottem s 17 Volt,
1ti'17 Abtl Swim
1!C kMJ M!I'rll turd it 1•+J4irtl CR,tJI(A,MC P`"
I1.01Welitiir dlimoters (0 \' (Ina) 13h,Vi a` to addition to OM*the ban VA who Whom In 24n
a ^ ohms,elan nubmU ono copy at this than within IC d of C�Ittion or welt
A2 Wen M7gKt11QKLM 111oWMt, i Y�1�J i w1 V� LIOOSInuctiofrntha fallnWISIA:
If,,.auRor.away.rank,ChTNn pntb,Iron,) tlA�t RNJatitl t C contra)Program.
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tl'OR WATtk REPPLIt wilat.ut ONLY: 1P,3s NAM BeeeteaCerium ifindoiRi.1IC274944636
i t.sR.YltldlR{Ae1).� (r`v 1 q 4 .lac. i r•Wont r SAtstetl afal>satlntLlVMP= In addltiot to mangle tilt him to
mg ftdla�S4(a4� eMonMetIHURat tags' A� submit env oopf of title than within 30 nor:of
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ILIA, hinfetelintt ,Anu►1A1t� - anm Mil of sl �e to the noway I*etth dmIRI tWO of Ike MOM
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moon clw_, Word C`.mnlina Daearimnat of Itiv..trorrnimIn1 Qnnthy-DiVIaiM%IA'WOW Ranwaaes RncAtee 2-2t-e l 6

fatkell
Will Mew Salf-411mat C.Vdn
O e.,1
New Will: y
On
Iliweby certify that ibe above rekrented well was grayed in appearance la a°0°nlance with
all county Wen roles.
cons: Grout
Total �o
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