GW1--06385_Well Construction - GW1_20241025

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4 Date tCelt(s)Conlplelc4s 10-
1-2024 WeflZD#AS 109:. ;
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FXI INC • • •• • • 'ti tt t ,
Factiu}..... .......anc:. .. " • • Faciliij m#(iraDplirablc)::" A ft.. ff . .�...:
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.18801;Old Statesville Rd,',•:CORNELIUS, NC, :28031 fl tt;... • I £ t' CQ24 . •;
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. Pht•s,Ctt1.lddress_City;arid 21 e t k,:,� x
y :�t2t.ttlhlARh.S �� $#i .'srf 3 3;<r� -:.
BENTONITE FROM 53 TO 54' . '�Jr
MECICLENSURG :,' •. . _ry
Canritj°:'" " . • •
Pale,3Id d,ttt4,lf(ioNo`(tiltt1,
rna Sb,l;antude and:l ong4uiic to dcg res/minutecrsecondf or dcctt d4Xnxes, ;;22 Ceraticatixrn . .
ae l(if .field,on.i-t'lo ifticktriy .:
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iii tla tl of this to honat I1 siie del
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8 l'untbei'ofwelts constritiled: 1 . . . =eo► ire oa data You,,t:t}°also 4116 ir:idtlitiotlal pates if bt.e an .
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• 9 Tottrl i'eltdettb belowlaritAlit'[;[e 6o (tY) 24a. Pit 411 W411 Submit this fornlr-vithin 30 dais pf completion of ttwelt
Forarrandilplc i tlII'listtdh!iptlis rfdtffiir+rtf'ranip3e 3030t1:".avj2ftI1T}, • .:;ctonstnliction to die,following
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11 Bw'elu►te tliamcter a;E5" (iq;) 246 Fix Inicctipn! ITh ONNLI .in addition to sending the fort to theaddr lar. •
. . 23a abo e,Ii1an submit a cops°of thus foruie•:.w llnn (i.[ta.s of.compteteou of till,:- '
12 Welt fan3tt11Ctlon nittltod AUGERS -:'CG+tlstrt.01.ln to•Lief,tollow Iii 1 .
(i a anek raL�q cables drtct Orscit etc)• • ,. .. :._ .. . . :
rnilslan of W'itel Resourixs,UJndet r and Injection Cotitrolpnigram.
- FOR WAT1�R$UPP,LY W EL S ON LY • I636 Mall Sena tcc Glint.Ra,lct);h,l\'C 2 X99 4636.
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L 24c.For Water Supply ec Injotdon WC11s
13a.lrlctc)(gpai). Method of test.. Also submit one cops° of;tins lonis.*1 hin 'ill d�t}sof:completton of
. ' 13b DisinfeLtiui npt ;. iifoont;,• <•: :i'e11 constnut►an;to the•count, health dcpinmc»t of the couril�inhale•-
con�tlircted
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