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ORIGINAL STATE OF CALIFORNIA DWR USE ONLY — Do Nor Flu IN <br /> IF <br /> File with DWRI WL COMPLETION REPORT I I I <br /> Page—LOfL ,�^ Refer to Instruction PmnF/det STATE WELL NO./STATION NO. <br /> Owner's Well No. /_I L✓^�0 No. <br /> 786687 I❑LATITUDE LONGITUDE ❑ <br /> _0 <br /> Date Work Began 10+LI,�"—o3 , Ended / ,/ <br /> Local Permit Agency •1 4` ^vi(�MYir�/c' -I <br /> Lj <br /> APN/TRS/OTHER <br /> Permit No. (32 351y1. Permit Date O-O <br /> GEOLOGIC LOG WELL WNER f,�y�, u c.• <br /> ORIENTATION (2) •�r—e/ LIG ( <br /> VERTICAL HORIZONTAL <br /> _yANGLE —SPECIFY) Name <br /> DRILLING <br /> METHOD stl'Yt-FLl_IID SUR �'I' r A Irl PO lJt1C�Yltr �dr+9 P' <br /> DEPTH <br /> PTH FRAC <br /> C DESCRIPTION <br /> Describe material, grain .size, calor, etc. clTv <br /> FI. Io FL WELL LOCATI <br /> Seed#A.Laj S. el, Address 30/ L <br /> City o <br /> Countv 5,C— _72esse.,e.^ <br /> APN Book Page Parcel <br /> Township Range Section <br /> Latitude I NORTH Longitude I i WEST <br /> DEG. MIN, SEC. DEG. MIN. - SEC. <br /> LOCATION SKETCH ACTIVITY (i ) <br /> C <br /> NORTH // NEW WELL <br /> ' xG l�•1[ /S/ /'��'�^ MODIFICATION/REPAIR <br /> W «ccViVN" _ Deepen <br /> Other($poetry) <br /> I � <br /> t DESTROY oeserne <br /> Procedures and Materials <br /> t Under"GEOLOGIC LOG") <br /> PLANNED USES (') <br /> WATER SUPPLY <br /> _ <br /> Domestic Public <br /> F F Irrigation _ Industrial <br /> 3 MONITORINGS <br /> I <br /> TEST WELL <br /> CATHODIC PROTECTION_ <br /> HEAT EXCHANGE_ <br /> DIRECT PUSH <br /> INJECTION <br /> VAPOR EXTRACTION <br /> SPARGING <br /> SOUTH REMEDIATION <br /> Illostmte ur Describe Distrtr¢e if Well front Rends,Sodding., <br /> Ricers,etc mrd nane/t rt ump Use additional paper it OTHER(SPECIFY) _ <br /> necessary.PLEASE BE ACCEIRATE&COMPLETE. <br /> WATER LEVEL & YIELD OF COMPLETED WELL <br /> I I <br /> DEPTH TO FIRST WATER (Ft.) BELOW SURFACE <br /> DEPTH OF STATIC <br /> WATER LEVEL (FL)&DATE MEASURED <br /> ESTIMATED YIELD ' (GPM) &TEST TYPR <br /> TOTAL DEPTH OF BORING Z IFeet) TEST LENGTH (Hrs.)TOTAL DRAWDOWN (FL) <br /> TOTAL DEPTH OF COMPLETED IVELL 2 .3 (Feet) ".Vlay not be representative of a well's long-term yield. <br /> CASING (S) DEPTH ANNULAR MATERIAL <br /> DEPTH BORE- <br /> FROM SURFACE HOLE TYPE(') FROM SURFACE TYPE <br /> DIA w a MATERIAL/ INTERNAL GAUGE SLOT SIZE CE. BEN. FILTER PACK <br /> (Inches) o GRADE DIAMETER OR WALL IF ANY MENT TONITE FILL <br /> oo (Inches) THICKNESS (Inches) Ft. to FL (V) (�) (�) (TVPE/SIZE) <br /> O g V G 9v O <br /> K Yov L L y0 .O <br /> I S <br /> ATTACHMENTS (vL) CERTIFICATION STATEMENT <br /> I,the undersigned, certify that this report is complete and accurate to the best of my knowledge and belief. <br /> Geologic Log <br /> K Well Construction Diagram NAME Gregg Drilling & Testing, INC. <br /> (PERSON, FIRM. OR CORPORATION) (TYPED OR PRINTED) <br /> Geophysical Log(s) <br /> — Soil/Wider Chemical Analyses 950 Howe ROa Martinez CA 94553 <br /> - Other Sj Paw• ADDRESS CITY STATE ZIP <br /> Signed teLAulP/li 5/21 /04 485165 <br /> ATTACH ADDITIONAL INFORMATION, IF IT EXISTS. WELL DRILLER/r HORIZED REPRESENTATIVE DATE SIGNED C-57 LICENSE NUMBER <br /> D1cR Ins BEC 11-117 IF ADDITIONAL SPACE IS NEEDED, USE NEXT CONSECUTIVELY NUMBERED FORM <br />