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ORIGINAL ST'TE OF CALIFOAXIA own USE ON,y � o NDT SILL Ir <br /> File with DWR WELL COMPLETION REPORT i f f r <br /> Wage—I—.f I lirfe r (a -5rr n ur r I rtrujll>trT STATE wELL NO/STATION NO <br /> Owner's Well No No <br /> Date I�'Ork Began Ended - _ LATITUDE <br /> -3 LONGITUDE <br /> L,t>cal Pe�in)tY�.gencv r 7c•� ,i y� C.cr.� /�" j GI ( <br /> Permit No AEol Permit bate '— / Cy car APn/ITR S/OTh�R <br /> GEOLOGIC LOG �y WELL O�'['i�ER <br /> ORIENTATION (�) �V'cRTiCAL HORUONTAL C�cju <br /> [TRILLING j . !� /� _ 1 _ <br /> METHOD f 'lr � � yJ7/ft�c-lr 4' kfaihn�Address 6-C.- <br /> Dr`P'TH FRDrt FLUID /�� [ /� � •• <br /> SURFACE DESCRIPfloN _JJ_ =y/ l` '::; �-i <br /> Ft to FS, Daicrzbu inatf rted gram SIS6 enlnr, PCC, CIT' C- STAT ' 21I <br /> 6-5 Ay- 1 y� M Address 3t'ELL�OCATIO\ <br /> City <br /> `i SY I <br /> AJ, 1 fC2 SYS' °SLY Coun <� C!r e 7 <br /> ' `° �1 APN Book_t2-3 C <br /> %c,�4C,,� page_ 1 I� I arse] Lir j <br /> Totmshlp. /V Ilan7e :E Scctlon <br /> 1 - <br /> NGRTH Lltude4YCV L, gh . <br /> 13 <br /> D:G M!H S.0 <br /> �,CJ , ' / ' , 3 LOCA?70\r SKETCH AC IVIT1 <br /> �y NORTH CJ r � 1 + C,G3NEW WELL <br /> rire <br /> G MOOI�iGATIONIR=aAI <br /> Deepen <br /> DIMr(57ei <br /> o <br /> ZIE <br /> rx s <br /> DESTROY(Desrn <br /> Under OEOLOWC <br /> ry /3~r r�r �-'_fCd[ r 1,", bt r°e'5 ,, � L-• �1 ' PLA\NED USES <br /> /'- •S� ! `yC`J'rCJ + G r7[�rc /� �. I d WATEDSUPPLY <br /> sti- <br /> ..cz Omesllt � PL <br /> Lu <br /> r 1 3. . r t ti l W n MONITORING <br /> TEST WELL <br /> CATHODIC PR07=CTION <br /> HEAT EXCHANGE <br /> �x <br /> ac DIRECT PUSH <br /> 1 1 F `, W <br /> { 1 F <br /> � Ih,4=_(.TION <br /> VAPOR EXTRACTION <br /> `I <br /> SOUTH SPARGING <br /> 1 I <br /> 71LettrnM ur IJeacr ilk lhstr ncc r f 1Vr1!{nm Iiaad� 73rer!lrlr s REMEDIATiOrt <br /> r 1 Fen= Rrt crt etr~and arrnrlr a moll so arrdlriunal 1"),r,f OTHER(SPECIFY) <br /> r nrteasnrij PLEASE bE ACCUIt4T$sr~COMPLETE <br /> r I WATER LEVEL tS YIELD OF COMPLETER ti'ELL <br /> I I <br /> D=-PTH TO FIRST WATER Z rt) BELOW SURFACE <br /> I DEPTH OF STATIC f ""� <br /> WATR LEVCL /a .� [r*) DnTp MEASUH=D • <br /> ' 1 ESTIMATED YIELD (GPM)& 7cSY ryPe <br /> TOTAL DEPTH OF BORING . ?Q (Fret) <br /> 7=-ST LENGTH (Hm-)TOTAL DRAWDOWN_(�) <br /> TOTAL DEPTiF OF GO>41PLETEn R ELL >• (Peet) 'May nor ba reprenmrarrve rrf 4 well's Ioatg_rmrr yield <br /> DEPTH 3ppE_ CASING (S) , <br /> FROM, SURFACE_ HOLE TYPE(:) FROMDEPTH SURFACE kA NTULAR MATERIAL <br /> INTERNAL GAUGE I IA TYPE <br /> (I©nches) w MATRlAL I I SLOT SIZE CE $_N- <br /> Ft to Ft GRADS D AMTE'R OR WALL IF ANY _ ONfTc �� <br /> (manes) THICKNESS [lnfios) FL to Fl M-NT T FILTER <br /> ./"PACK <br /> 7/ 1 I Vic I IS< I <br /> r i t r I i <br /> 1 A'I'T'ACHkiE!\tT5 I 1 I <br /> CERTIFLCATJO� STATEMENT <br /> Geologic Log I the undefrslarted/Ser Ify that tills' report Is COmalete and a4.r-ale to the best o;my knowledge and belie` <br /> WeII Cor�structron Dag am nAnr, v u✓T FF'1 (.f",2w r-Ash r 17 t E?J S <br /> _ Geophysical La2(s) (°cRSON FIRMA OP CD2°pRAT)ON) (TYPED OR PPIHTED) - <br /> SO WJaler Cheml_al Analyses c p j;� f G C-C-'x-cif Fa-C� f� ��� <br /> Other AppRESS CfiY Y <br /> STATE zlr <br /> A TTACY AD7ITICWAL rNFORMATIprt IF rT EXISTS Srq,ed CJ l7/ !" " <br /> .L ORI LERJAUTHDRZO REPRESENTATIVE {GATS SI3h_p ` <br /> C n)UC'N7 5 NUM3:p` <br /> D11 166 tiSv J r, IF ADDITIONJAL Sc'ACE IS NEEDED DISE NES CON'SLC[JTI`✓ELY NUN3_R>_D FORM, <br />