Laserfiche WebLink
I ORIONA <br /> ll- "Ilk ll UI ( n111UI;hIA WR usF ONLY — D NOT rIl ( IN <br /> 'File with DWR N'VE?I.I. COMPLEMON RIAPORT <br /> P I�,L— Of 1,lb, ro lnrrrarrrnrl 1 amplilrt STATL WELL NO (STATION NO <br /> r <br /> O„lit I , Wdl No No 434198 I I 1 I = ❑ I I I I I ❑ <br /> OIt( Woil IIILIn J� Z Iud(d N'?Z LATIIUOF LONGLIUDE <br /> of d V(milt Ag(�w N rxL- <br /> I'(Y11111 NII] _ 7 G. d - --- Pt I IHIt 1)It[ <br /> zz Z. At N/1N5rOrHCfT <br /> C I OI 0{ I( 1 O( 11 I I I f1►111 R <br /> ORIENTATION VERTICAL _ HORIZONTAL _ ANGLE (SPECIFY) N 1 L.Lj111I <br /> DE--FROM III Ill II TO FIRST WATER—(It) 131 1 OW SUI;I A(I Xl ruing Addr(s% /010, QQX ISL <br /> SURFACE D E SCR I PTI O N J Zp/ <br /> Ft to Ft 1)eiLTlbe marerral grain size color etc CITY STATE ZIP <br /> WI I I I OC&I ION <br /> lt� <br /> ( (ount< cS / TpA V,Al _ <br /> PN Boot. Ptgc PIr((I <br /> or <br /> I0%ti1151111) Range 5(,_[loft <br /> or <br /> Latltudc NORTH 1 011git1ldLDEG WEST <br /> i i MIN SEC DEG Mw SEC <br /> LOCATION SKFTCIIC <br /> TIVIT] {�} <br /> NORT/H^T-� �-�`y/�� NEW WELL <br /> MODIFICATION/REPAIR <br /> Deepen <br /> —Other(Specify) <br /> i <br /> DESTROY(Descrrbe <br /> Procedures and Materials <br /> Under GEOLOGICLOG) <br /> PLANNED USF(S) <br /> 3 tau (�) <br /> MONITORING <br /> WATER SUPPLY <br /> i <br /> — Domestic <br /> Puplic <br /> Irrigation <br /> rL7— Industrial <br /> f TEST WELL <br /> ' — CATHODIC PROTEC <br /> SOUTH TION <br /> i i lHEA6TH 111us(ralr or Describe Durance of Lyell from I arld7narl s _ OTHER(Specify) <br /> I such as Roads Buildings Fences ffi crs etc <br /> P1 EASE BE ACCURATE G COMPI FTE <br /> DRILLING CC1Jlln _ <br /> METHOD FLUID <br /> WATFR LEVFL h YIFLD OF COMPI ETED WELL <br /> DEPTH OF STATIC S1/ k1 n <br /> WATER LEVELL. (Ft) & DATE MEASURED G. <br /> ESTIMATED YIELD (GPM) & TEST TYPE <br /> rrOTA <br /> TAL DEPTH OF BORING �(Feet} 1 EST LENGTH (Hrs) TOTAL DRAWDOWN (Ft) <br /> L DFPTFI OF CONIPLETLD WELL � (Feei) `May riot be 7eprewwatrve of a well r long ter»r yield <br /> DEPTHRARE DEPTH CASINC(S) ANNUI AR MATERIAL <br /> FROM SURFACE HOLE TYPE FROM SURFACE <br /> TYPE <br /> DIA z m W MATERIAL/ INTERNAL GAUGE SLOT SIZE <br /> Ft to F (Inches) a o� a GRADE DIAMETER OR WALL IF ANY CE <br /> t t, u MENT TONIN <br /> FILL FILTER PACK <br /> (Inches) THICKNESS (inches) Ft to Ff (TYPE ISIZE) <br /> 2 5 Z Sc I-f 46 ✓ <br /> O O O <br /> 24 <br /> O ✓ LS#3 <br /> d 1.3 16/ <br /> ATTACHMENTS (�} CERTIFICATION STATE "IFNT <br /> �saV/ ogic Log I eol the undersigned certlly illat this report Is complete an(taccuryte to the best of my knowledge and belief <br /> Welt Construclion Diagram NAME <br /> Geophysical Log(s) (PER R R C RPORA ON) (TYP�RpRINL'( <br /> SO'lI Waler Chemical Analyses — js <br /> V1,0IAer L0C -�'?11/V SS�"y�/�/� ADDRESS -CITY STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION IF IT EXISTS Segued <br /> f <br /> WELL DRILLER/A THO,z REPRESENTATIVE T SIGNED G 5 LICENSE NUMBER <br /> DwxPis llF\ -yp IF ADDITIONAL SPACE IS NEEDED USE NEXT CONSECUTIVELY NUMBERED FORM <br />