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Get TX TDLR 001 WWD 2017-2024

Exas 78711 Toll free (800)803-9202 (512)334-5540 Email address: water.well@tdlr.texas.gov Web address: www.tdlr.texas.gov This form must be completed and filed with the department and owner within 60 days upon completion of the well. WELL REPORT A. WELL IDENTIFICATION AND LOCATION DATA 1) OWNER Name: Address: City: State: Zip: Physical Address: City: State: Zip: 2) WELL LOCATION County: 3) Type of Work [ ] New Well [ ] Reconditioning [ ] Replacement [ ] Deepening [ ]Other___________.

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