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011GINAL STATE OF CALIFORNA o us ON Y 1— o F i <br /> File With DWR WELL COMPLETION REPORT <br /> Page__._ofRe/er to I7Rrtrucrrna Pa7up6lea <br /> STATE WELL NO ISTATION NO <br /> Owner's Well No. No. 465027 El <br /> Date Work Began Ended !D 6 LATITUDE LONGMUDE <br /> Local Permit Agency ..t <br /> A NIT <br /> Permit NO ����L� _— Permit Date �O a <br /> GEOLOGIC LOG ���/} WELL OWNER <br /> ORIENTATION VERTICAL _HORIZONTAL _ANGLE —(SPEGFY) Nart ` - <br /> DFFM TO FIRST WATER (FL)AELOW SURFACE Maifhig Addrm ' <br /> DsITHFFjEM DESCRIPTION �{ " OZ <br /> Ft to Ft Derenbe mate-nalgramsize,color;etc ! `4`, CITY W E T,f 0 C A T i O N STATE ZIP <br /> ` Address` <br /> i , }�apnly <br /> ::�? 40 � '' A Bank ageParcel L <br /> Towushtp.Range Section <br /> or – <br /> wpA a Latitude_ � . NORrN Long►tucle ylesr <br /> � , ,, , � - _ DEG MIN 9EC REEL MIH SEC <br /> LOCATION SKETCH AIYITY (.!L) <br /> NORTH NEW WELL <br /> MODtmcATIONIReFAIR <br /> _ ', Deepen <br /> Other(Spsc110 <br /> Cesmoy Meacnba <br /> } pmeederesandufftedab <br /> Under[tl:OLOG1CL06 7 <br /> rPLANNED USE(S) <br /> i r _ <br /> -PLANNED <br /> WATER SUPPLY <br /> Domestic <br /> r I <br /> Pae¢e <br /> hdoatlon <br /> Induslrlel <br /> TEST WELL <br /> }e� WPf <br /> cartivolc PROTsa <br /> SOUTH TION <br /> r Illustrate or Describe Distance of Weil from rdndr,rarAx —OTHER(Specify) <br /> z such as Roads Buildings,Fences Rivers ale <br /> PLEASE RE ACCURATE dr COMPLETE <br /> s , <br /> DRILLING <br /> METHOD FLUID <br /> ' WATER LEVEL & YIEL OF COMPLETED WELL <br /> DEPTH OF STATIC <br /> � <br /> WATER LEVELf (Ft) a DATE MEASURED <br /> ESTIMATED YIELD' (GPM) 5 TEST TYPE <br /> TOTAL DEPTH OF BORING ,a (Feet) TEST LENQTH , (Hra) TOTAL DRAWDOWN (Ft) <br /> TOTAL DEPTH OF COMPUTED WELL (Feet) 'may mat be represenranve of a well's long-term yield <br /> DEPTH CASINGS) DEPT14 ANNULAR MATERIAL <br /> ROSE- FROM SURFACE TYPE <br /> FROM SURFACE HOLE TYPE <br /> INTERNAL GAUGE SLOT SIZE CB- BfN <br /> DIA. z o �+ MATERIAL/ DIAMETER OR WALL IF ANY Ffi TERR PACK <br /> (Inchas7 1 GRADE MENT TONITE: FILL PE/SIZE) <br /> FI to FI (Inches) THICKNESS (Inches) Ft to Ft ✓ � � (TY <br /> i <br /> Q D SL I X 11 Q0 b <br /> 0til 0- a s ' alga <br /> .o, 6010 <br /> i <br /> i <br /> 'ATTACHMENTS CERTIFICATION STA'T'EMENT <br /> I.the undersigned,certify that this rg@port is complete and accurate to the bast of my knowledge and belief <br /> GeoSogic Lau l <br /> — Well Construction D+ayram NAAlE <br /> (PERSON, FIRM OR CORPORATION) (TTPED DR I71! <br /> — Geophysical Logs) l <br /> U <br /> So Water Chumlcat Analyses ` b ` <br /> � ESS GlY STAT 21P <br /> — Olher ff Z��I g <br /> ArrACH ADDFTmo&AL INFORMATION.FF IT EXISTS Signed 9A o C-57 LICENSE NUMBER <br /> WE lze�R REP SENTAIff <br /> DWRtBAaFY 7-00 IF ADDITIONAL SPAC NEEDED, USE,t CON 6nvELY NUMBERED FOA <br />