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OR[GiNAL STCFS OF CALIFORNIA FLDI.WR USE Dl1LY � pDFDte with DWR WELL COMPLETION REPORTPage/Of rirfrr to ,ltn, eor rrtn ,hdt STATE WEEhIOLISSTA�IDNOwner's Well No �� (� hoDate Work Beffan L "�' 7 rZ � I �h E71C�E'U— 7 - 7 TI7?jor LONGITUDE <br /> L(LA Permit Arrerim �f'��y�c���r 77 L cs /� <br /> 0,- <br /> Pe )\TO . Sr> 1 <br /> _ Permit Dae e, /� . C�e� A KITR SI?TFiEA <br /> ,` GEOLOGIC LOG ' WELL{OWNER <br /> OSI-`NTATION {�; C VERTICAL HORZONTAL —ANu`LE (SP,GIFYI ]�dlna <br /> [TRILLING - ` drl <br /> DEPTH FROM M='HOD �"� J ��� -��FLU3D 412- W alllno•Ar ss <br /> SURFACE I7ESCRIPfIOh <br /> j�caC r c at to Ft Dcscrthc ,,,utr-MC11 grletn rrCc Calnr et,, DITr <br /> STATE 2 <br /> r - <br /> Addr -'ELL LOCATIO\ <br /> + 1 ,G1 i� �/�• �� /'� 7 ess ' _�-y { f (cf7: /Grip <br /> W .1/lc �c <br /> Ef.C% r ,Z]o rT. ccr� County ^_, IGSCp %Cfr -- <br /> // APN Book_t23 I'a�e <br /> _CCvc �/m•Gxr 3'� r' <br /> Townahlp _Range Section <br /> Latitude NORTH Longitude <br /> DEG MIN SEC DEG MIN Sc <br /> LOCATION SKETCH _ ACSIVITY <br /> NORTH1/ <br /> NEW WELL <br /> �f f MObIFIGATlONIREP/ <br /> *DesPen <br /> r r F'•1 -c G✓ �'4 0 G — Other(Sa4 <br /> r ' (j DESTROY(pest <br /> Pmcedvre5 incl. <br /> ' r R t 9 Uh;tvr"GEOLOGI <br /> ' FEv' 1 ' PLED USES <br /> ANTWATER SUPPLY <br /> 1� 1 _� Domeslw^ P <br /> Lu ��,,,,.tom""^ Irnpetrvn Ir <br /> MONRORft <br /> irrr r TEST WEL <br /> CATHDDIG PROTEGrrDI <br /> HEAT EXCHANG' <br /> DIRE-Cr PUSF <br /> rr.,IECnot <br /> VAPOR EXTRACTIDh <br /> r r SOUTH SPARGINC <br /> lrinsfmtc or ITaar,rbc 7J+s1m,n-of lYrlr(tour Ronr(s Rr==lrtr,r�s REMEDIAT$Oh <br /> For= Rlr,crs e!C_m,rf erred,n reap tw rrr,rlrt,una)nrrytt r rf OTHER(SPeCtFYI <br /> nrrrssnrrl PLEASE HE ACCURATE e, COMPLETE <br /> ` WATER L TEL Ce YIELD OF COMPLETED FELL <br /> I r DEP'r H TO FIRST WATER-1F'6 (rt) gcLOW SUr4FAC= <br /> ' r D=7TH OF STATIC r _ <br /> a , WATER LEVEL /,76 (_•�&DATE MEASUR=n <br /> TOTAL DEFTI3 OF BORING � I'^et? ESTIMATED YIELD (GPM)s TeST TYPE <br /> ( <br /> TOTAL TEST LENGTH (Mrs)TOTAL DRAWDOW DFPTII OF COAIPLETEf) �S'ELL �.r� (fleet) "L_(�7) <br /> "May nos be reprrscnrarmc rf A u 4pi Imlg-rmtt yield <br /> D`FSORE- CASINTG (S) °-PTH 11\'N'UL4R biAT$P.IAL <br /> FROM SURFACE HOLE TYPE f z) <br /> DIAFROM SURFACE <br /> (trwh� Y w o- 31-OT MATERIAL! INTERNAL GAUG; TYPE <br /> SIZE <br /> Ft to FL ) GRADr DIAMTR Or'� WALL IF ANY CE $`N FlLTcR PgCF <br /> �' r'r�, LL (rnci,es} THlCKN`cSS pnehes) E1 to Ft MENT TON(TE FILL JLTZRSl2E <br /> Ic 4C� Cl - : <br /> Cl J <br /> .� 7 CJ ICra r ✓� s t� <br /> ATT4CFI)4fENTS (T) CERTIFICATION STATENfEiv'T <br /> �Geologic Log I the unde sinned certify that this report Is complete and aGvurate to the best Df m <br /> ��VJell GorslrUstron D agPam <br /> NAME �i�[f 4•;e—ji �'`e y-- Y knowledge and belief <br /> LJ- �- [�`�� !�7'PCi" <br /> _ Geophysical Log(s) (PERSON PIPM W LDRDDRA'HUrt) (TYPED OR P?IP(TED} <br /> 5ortrWater Chemical Analyses :r C- kir e,- C/ e,/- !l" � p��r i� C �� <br /> Other ADDRESS CRY I` Cf,, <br /> ATTf,CYD <br /> A71TlONAL INFORMATION IF!T c'XISTS Sg•,ed ASE ZIP <br /> PRlfl��,f'-':G y r�7 FS-�- I'LEFtlFUTK(lR (ZED REES--NTAn< <br /> 13WS 188 REV 11 91 IF ADDITIONAL SPACE IS NEEDED EIS£ NEXT CON'S=C1, 1✓_LY NUMBERED FORM C��uc ns- NUM9,R <br />