Laserfiche WebLink
i • <br /> The free Adobe Reader may be used to view and complete this forth. however,software must be purchased to complete,save,and reuse a saved forth. <br /> File Original With DWR State of CaliforniaONR Use Not Fin In <br /> Well Completion Report <br /> Page ` of Relerte InslniCicn Pamphtet ��$tale Well NumbedSite Number <br /> . Owner's Well Number /h L,.--1 No.�0,95p 26 N <br /> Date Work Began (- 'i Date Work Ended OS_ Let.w Lon kWe <br /> Local Permit Agen� ��✓%. ��� <br /> Permit Number S'77 -Smarr..% Permit Date G/Z-a 5 ? APN/lRStOlher <br /> Geolo is Log Well Owner <br /> Orientation &Vertical 0Horizontal OAngle Spea Name o <br /> Drilling Method Ln /vz✓4'. Dolling Fluid Mailing Address ZQ�s ri L" ✓g <br /> Depth from Surface Description C <br /> Feet m Feet Describe material, rain size.color,etc city State!�O 71 <br /> Well Location <br /> L111-4- Address3o l <br /> .. City . �ct4,.. County-S.,- .Tat <br /> Latitude N Longitude _---N <br /> r3iC e(� L Det Min. Sac. Den Mn. Sec <br /> Datum Decimal Lat.-Decimal Long. <br /> APN Book Page Parcel <br /> .^ (�, yz Township -Range Sector <br /> Zr Few . ,, ,.,C, Location Skgtch =Jannd <br /> ti <br /> (Sketdi mNetbs'drwnb Mrq elbrkimtU orad. l <br /> on/Repairen ivh e.m„moria`oaaiao�.ed Uses <br /> ° O Water Supply <br /> \� ❑Domestic []Public <br /> ❑Irrigation ❑Industrial <br /> ahcProtecton <br /> O Codi <br /> '� \ O Dewatering <br /> • ���„ ,-_ � O Heat Exchange <br /> ° O Injection <br /> �C Monitoring <br /> t O Remediation <br /> O Sparging <br /> ...a,.e,.a...,. .., <br /> O Test Well <br /> auea.a.a..va.a.ti,uawkan,me.,ruwry..t.o.: O Vapor Extraction <br /> . ,rw,.,en.a'.aea�Anw uaaaaawrr.cwr,.eaan.-.L�r— <br /> LaOthor <br /> t, V0fjYLeve!4mfV6jd`ot Corti"IC1100,'11i. <br /> Depth to first water (Feast below <br /> Depth to Static <br /> Water Level. (Feet) Date M <br /> Total'.Depth of Boring Estimated Yield' G :est Type <br /> <---z - - Test Length- (Hours)Total Dmwdown_(Feet) <br /> Total Depth of Completed Well Feet ere resentathre of a we <br /> longterm yield. <br /> Caeln s Annular Material <br /> D"Miran fkrsholie Wall outside : :Season Slot Size Depth from <br /> Mabrial <br /> Surface Diameter Type Thickness Dlomater - Type It Any Surface. Fla Description <br /> Feet. :to Feet Inches Inches Inches Inches- Feet to Feet <br /> Attachments Cettlflcadon Statement <br /> 11 Geologic Log 1,the undersigned,certifythi re coni 'te�nit a best of my knowledge and belief <br /> V' F13 Well Construction Diagram Name <br /> 13cerpera ( A <br /> Geophysical Log(s) CkY st.ts <br /> ❑SoillWaterChemical Analyses Signed <br /> 11 Other <br /> �ad inkan,lem e e earn, csT watww.r Dale Si rte C-67 License Number <br /> oWR IN REV.12006 IF ADDITIONAL SPACE IS NEEDED,USE NEM CONSECUT LY NUMBERED FORM <br />