Laserfiche WebLink
ORIGINAL <br />File with DWR <br />Page of <br />Owner's Well No <br />Date Uorl, Began. <br />Local Permit Ag <br />iPen-att No _ <br />ORIENTATION (:�. ) <br />FROM <br />FL <br />STATE OF CALIFORNIA <br />WELL COMPLETION REPORT <br />Refer to Instruction Pamphlet <br />�l►�,1No 729635 <br />GEOLOGIC LOG <br />+! VERTICAL —HORIZONTAL —ANGLE —(SPECIFY) <br />DRILLING <br />METHOD FLUID <br />DESCRIPTION <br />Describe material grain size color etc <br />fry <br />STATE WELL NOISTATION NO <br />0 <br />LATITUDE LONGITUDE <br />APNITRSIOTHER <br />.TION <br />Z ; <br />Addiess . f CC�u-,u..�.� . <br />city <br />t t Z I , <br />r i'j 15"4 <br />Cot.inty S ,n 4 LII n <br />AP\ Boot. Page Parcel <br />ToNviTship Range Section r <br />Latitude. I I NORTH Longitude 1 1__ .._WEST <br />DEC MIN SEC DEG MIN SEC <br />LOCATION SkETCH CTIA I (.:!L) <br />NORTH NEW WELL <br />_ — MODIFICATION/REPAIR <br />_ Deepen <br />—other (Specify) <br />—DESTROY IDescrrbe <br />Procedures and Marerla6 <br />.J Under GEOLOGIC LOG <br />I 'Z 1 <br />�j <br />ilk- <br />i i <br />' I ( <br />1 1 <br />5-7 i I <br />) <br />r bar �, <br />3-7 PLANNED USES i t ) <br />WATER SUPPLY <br />I <br />Oomesuc Pu6hc <br />Irrigation — Ind" 1j <br />L ¢ MONITORING <br />TEST WELL — <br />1 i <br />1 I <br />t r <br />CATHODIC PROTECTION _ <br />1 <br />�•/ 1^�((� { a �:/"• HEAT EXCHANGE — <br />I <br />DIRECT PUSH <br />PF 1 1 <br />INJECTION <br />VAPOR EXTRACTION — <br />SPARGING — <br />r I <br />I i <br />SOUTH REMEDIATION — <br />111nstrate or Describe Datance of i4ell from Roads Bnddnlos <br />Fences Retem etc and attach a amp Use additional pyaper If OTHER (SPECIFY) _,,._ <br />i I <br />r ' <br />necessarrJ PLEASE BE ACCURATE L- C031PLETE <br />' <br />WATER LELEL do YIELD OF COMPLETED F' ELL <br />I I <br />DEPTH TO FIRST WATER (Ft) BELOW SURFACE <br />1 t <br />DEPTH OF STATIC <br />WATER LEVEL—i!;11-12 (Ft) & DATE MEASURED <br />r I <br />t I <br />ESTIMATED YIELD {GPM) & TEST TYPiE <br />TEST LENGTH (Hrs) TOTAL DRAWDOWN (Ft) <br />TOTAL DEPTH OF BORING (Feet) <br />r <br />TOTAL DEPTH OF COMPLETED 1,4 ELL {Feet) <br />' )lay not be repiesentaii of a Zell s long -feint yield <br />CASING <br />(S) <br />DEPTH ANNLLAR MATERIAL <br />DEPTH <br />FROM SURFACE <br />BORE <br />HOLE <br />FROM SURFACE TYPE <br />✓ <br />TYPE(—) <br />DIA <br />w <br />y z a_ <br />z Z a <br />MATERIAL! <br />INTERNAL GAUGE SLOT SIZE <br />DIAMETER OR WALL IF ANY <br />CH BEN <br />MENT TONITE FSLL FILTER PACK <br />FI to Ft <br />{Inches) <br />S _ <br />GRADE <br />(Inches) THICKNESS (Inches) <br />Ft to Ft .- (TYPFJSiZE) <br />F <br />L 0 <br />�^ Vol <br />s r <br />1 <br />g <br />G Li! <br />� ✓ <br />33 <br />I <br />r <br />' ATTACHMENTS(—') <br />r <br />CERTIFICATION STATEMENT <br />I the undersigned, certifythis report is complete and accurate to the best of my knowledge and belief <br />— Geologic Log <br />that <br />V r i <br />4 LCA Ori <br />— Well Construction Diagram <br />NAME (PERSON FIRM OR CORPORATION) (TYPED PRINTED) <br />Geophysical Log{s) <br />%j '3 -q -7 1 <br />l LsAryli. <br />l <br />`I <br />_ $t)II/Wafer Chemical Analyses <br />_ other <br />j/ <br />CI� �d�/�` STATE <br />ADDRESS <br />3 W Zq [� <br />ATTACH ADDITIOVAt INFORMATION IF IT EXI$T5 <br />Sgined DATE SIGNED C 51 LICENSE NUMBER <br />WELL L lAUTHORIIED R TATI <br />Dii R lyti RE1 It 11' <br />tF ADDITIONAL SPACE IS NEEDED USE NEXT CONSECUTIVELY NUMBERED FORM <br />