Laserfiche WebLink
ORIGINAL STSTE OF CALIFORNIA DWR USE NLDO NOT FILL It <br /> File with DWR WELL COMPLETION REPORT <br /> Page_L_._o£ RrJCY rn rsrr,+ [)1 Iamphlet STAT= WALL NO./STATIONNO <br /> Ow-net's Well No r I / �1�'A No f I E <br /> Date Work Began -7 '.2=�C--/ Ended -=°Z/ LATITODE LONGITUDE <br /> Permit NTo , Q �- `%� j Permit Date CJG APN1i,RS107HER <br /> GEOLOGIC LOG WELL OurNER <br /> ORI>_N7ATION (�) !V=RTICAL —HORFOtr ,ISP-GIS N.t1Tle_ <br /> AL —ANGLE T � <br /> DRILLING <br /> DEPTH PROM MET OD C.I^1 Jr —FLUID /"w[. 7 Maitipg Address <br /> SURFACr DESCRIP' 10k ,( <br /> Ft to Fl. Dr iGr:he naat4rcrll ;;roan 42;;e C010r etr CITY _ STAT_ TU <br /> '- J�scl �i'ELL LO�CATIC+\1 <br /> Address ( <br /> CDilAt) - .�a'7 ys�1t"0�`[�i 6? ....� <br /> 1Ca r c +� rc e vi APN Book f Page Parcel r <br /> S./ r�c, h ;i�, Town lip ,r�'Ran;e �%� 5ectlon <br /> ✓� ' /�� ' :� �f Ps^" �'j r UtltUde-DEG. I MIN. I SEG. RTW Longitude <br /> �'e 'O�'Y� / DEG MIN SEr <br /> j c/ � LQGATID'V SKETCH ACS IV[TP { <br /> ' NORTFI NEW WELL <br /> E7 + l C'C3 t �ltc �! Ca /��C31etej r e -I 6� +r !`�� <br /> 'nL i 5,; �CAC.,C � — Deepen <br /> � MODIFICA 10NIR PA <br /> Other 5 e <br /> t [ e✓ °� <br /> DESTROY{Deser <br /> Procedures end M <br /> Umer GEOLOGIL <br /> r jW ; f1ti PLANNED LISES <br /> + a _,_0*n4� r 1 WATER SUPPLY <br /> Demeshc Pi <br /> rj' Imyatron in <br /> MONrTORfN( <br /> 3 r <br /> GF TEST W=U <br /> _ }` CATHODIC PROT-=T1Or <br /> HEAT EXCHAWuc <br /> A+rR <br /> DIRECT PUSF <br /> IAJECT101, <br /> I 1 <br /> VAPDR E_TRAAL'Tloh <br /> r 1 SOUTH SPARGING <br /> Tlrilomte or DenTibe Divem z'of 1Yrll frn+u Ran& Blutfirrr r REMEDIATION <br /> Frners RmL r7 ec and rn eirft n merer re nnrhtiun` a!�>rr),[",f OTHER{SP=CiFY) <br /> r t nec=rInj PLEASE BEACCURAIE&COMP <br /> 1 + WATER LEVEL s YIELD OF COXIPLETE7.) WELL <br /> r r DEPTH TO FIRST WA T EFS (Pt) BELOW SURFACE <br /> 1 t DEPTH OF STATIC /,,7�/ r7 ,rF <br /> + WATER LEVEL— (7 (rt)A DATE MtASLskEU ` <br /> ESTIMATED YIELD (GPM) & TESTTYP <br /> TOTAL DEPT}( OF BORING � (F^et) TEST LENGTH (Hrs,)TOTAL DRAWDO <br /> TOTAL DEPTIr OF COMPLEM) WELL wry"---(Ft) <br /> {Feet} 'May not be rep es=rarrze Ufa Tvelrs lmlg-rersu)Feld <br /> DEPTH CASING (S) <br /> FROM SURFACE HOLE DEPTH AN^'LTLAIt hrAIEItIAL <br /> TYPE{�) FRQ)v[ SURFACE TYPE <br /> DIA a MATERIAL I INTERNAL GAUGE SLOT SIZE CE BEN <br /> FL to Ft <br /> (Inches) v GRADE DIAMETER OR WALL IF ANY M>:N7 TDNiT`c FILL FfLTER PAC( <br /> (+nsttes) 7HIGrSNcSS jlnchos) Ft to Ft (TYPEISRE) <br /> � <br /> 2- <br /> ff I I <br /> I I I <br /> + I I <br /> ATTACHRIENTS (t) I CERTIFICATION STATEhfENT I <br /> !, the Undersigned cerzify that thrs report 1s Complete and acCJ2te to the best of my knowledge and bell=f <br /> Geologic Log f � <br /> r WBII Cnrstrict+on Diagram NgMc (/>r ,y r •'h Lr-G c> — <br /> Geoph)stcal Lop(s) (°iRSON//FIRM DP CDPPORATIDN) (TYPED DR PRINFED} y <br /> So11NJater Chem:cal Analyses ?r L.l� <br /> .,. Other ADDRESS CITY STAT: IIP f <br /> ATTACH ADDIT10NAL INF'JRMATION IF 1T EXISTS Signed `Q-�T.jG CK ��j tQ�C 7 <br /> v3:L ILi=WAUTlipRi2fp r2EPRE5.NTATlYi DTE SC NEp ) J <br /> C SJ LlC:(iw= itllMg=p <br /> UAR 183 RZ-V it 91 IF ADDITIONAL SPACE IS NEEDED USE NEXT CONSECUT(JELY N'JM@_=A_=D FORM <br />