Laserfiche WebLink
-The free Adobe Reads,may be used to view and complete this form. However,software must be purchased to complete,save,end reuse a saved farm. <br /> File Original with DWR State of California DWR Use On -Do Not FIR In <br /> Well Completion Report <br /> Page r_ of I� Relerto Inatnxtion Femphrcf Stale Well NUMpar iM Number <br /> Owners Well Number —/" t Ir/ 5 No. e0095024 I I I Iy N III_i II LJ.J`" <br /> Date Work Began20, Date Work Erdetl Latitude Lan tulle <br /> Local Permit Agen <br /> Permit Number S7 7�3 Permit Date ��2-0 9 Q-S.-� APNIfRS/Otner <br /> Geologic Log Well Owner <br /> Orlentation Vertical OHorizontal )Angle Speofy Name �� <br /> Drilling Method rG a r Drilling Fluid Mailing Address <br /> Depth from Surface V Description. FA��^ - 1 q,Q Slo <br /> Feel m Feet Describe materiel, rain size,odor,elc C state <br /> ✓ Well Location <br /> Address5�4 2 Cary c !4County SSA <br /> Latitude N Longitude <br /> Dec. Min. Sac.. Deo. Nln. Sec. <br /> Datum Decimal Lat. _ Decimal Long. <br /> APN Book Page Parcel <br /> Township Range- Section <br /> Location Sketch Activity <br /> Sketch mustbe drawn b hna aroule m is ilnted. O New Well <br /> O Modification/Repair <br /> O Deepen <br /> O Other <br /> AQ_De bPmnJuw aatlMelaY <br /> ... we.•aEOLaafL Los, <br /> /� `• PlannedUses. <br /> O Water Supply <br /> .h <br /> []Domestic ❑Public <br /> ••S ❑Irigation ❑Industrial <br /> O Cathodic Protection <br /> O Dewatering <br /> • ry O Heat Exchange <br /> ......... O Injection <br /> 0 Monitoring <br /> O Remediation <br /> O Spafging <br /> _ O Test Well <br /> uwtiew anae.eu.hm wvsrmniwa.;waay..k�, O Vapor Extraction <br /> ...k„,e mrA..maP arb aemuaw Pwoere .r O Other <br /> PlweGcuv6tgcvm <br /> ater Level and Yield of Completed Well <br /> Depth to first water (Feel ce) <br /> Depth toStatic - <br /> Water Level (Fe ate Measured <br /> Total Depth of Boring- Feet Estimated Yield (GPM) Test Type <br /> Total Depth of Completed Wel Feet Test Length,,,(Hours)Total Drawdown_(Feet) <br /> *Mav not re resentative of a wen's iona term yield. <br /> Casings Annular Material <br /> Depth from Diameter <br /> "Type Material Wall outside Screen Slot Size Depth from <br /> Surface dafneter Thickness Diameter Type NArty Surface Fill Description <br /> Feet Is, Feet Inches Inches Inches InUes Feel m as <br /> Attachments Certification Statement <br /> ❑Ge 09 C Log I;the undersigned, t t is rt pkte late to the best of my knowledge and belief <br /> fi <br /> ❑ Well Construction Di m Name IL <br /> ❑ Geophysical L .Firm« - r _QA <br /> ❑ SoiUWater C <br /> cat <br /> Analyses C4 byy LCT///➢a� <br /> ❑ Othernse lTm' <br /> Attest l a eaaan. _ csr wrier cenu.aor. C-57 Licen88 Number <br /> DWR IN REV. IF ADDITIONAL SPACE IS NEEDED,USE NEXT.CONSECUrVELY NUMBERED FORM <br />