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„ ORIGINAL SI I I I ()1 ( kill ORNI D W Rs Y — D 0 N T F h L <br /> File with th DWR WELL COMPLETION REPORT <br /> r• <br /> PJJ.•,(,_y f)1 � Rc jmr to I>rsrruon !'[� <br /> �ti �'} rnphSTATE WELL NO/STATION NO <br /> l�r ❑ <br /> Owncr% Well Nn _ �+ L/ No -s U J 2 O 7 <br /> D lie Work 1k gan J Z//V,5e- Ended �-- LATITUDE LONGITUDE <br /> [.fetal P(rmltlgencv.Y��✓ lfZ��-sisN__Gnr�^�'tV �N �n�•y..ru.lHta/ <br /> P(rmlt NO _�!� -.3rf S _ permit Dale 12-11,64-1z. H APNITR r T <br /> GEOLOGIC LOG WELL OWNFR .y�j <br /> I-ORIENTATION (!} VERTICAL •�— HORtZONTAL _ ANGLE _ (SPECIFY) Name C YS f ati cL P-d -�'t I _�C+ <br /> —IDr3 � s7 - <br /> DEPTH FROM DEPTH TO FIRST WATER (Ft) BELOW SURFACE Mailing Address _—_ <br /> SURFACE DESCRIPTION <br /> Ft to Ft Describe material grain sire color etc CITY STATE ZIP <br /> WELL LOCATION <br /> Address - flay ,ri r <br /> City S ty 4C-A_' ••1-17 <br /> County SAN �C zp- SG_cy/,J _ <br /> APN Book Page Z a/� Parcel_'7'i - <br /> Township Range Section <br /> Of <br /> Latitude I I NORTH Longitude —T WEST <br /> DEG MIN SEC DEG MIN SEC <br /> LOCATION SKETCH I VITY (�) <br /> NORTH Ew WELL <br /> ' <br /> MODIFICATION/REPAIR <br /> i <br /> —Deepen <br /> V-1, <br /> —Other(Specify) <br /> DESTROY(Deacnbe <br /> V (J Procedures and Materials <br /> Under GEOCOG)CLCG ) <br /> -- -PLANNED USE(S) <br /> w a T} <br /> MONITORING <br /> i <br /> ' /I WATER SUPPLY <br /> Domestic <br /> _/w- Public <br /> Irrigation <br /> � Industrial <br /> � TEST WELL <br /> ' CATHODIC PROTEC <br /> SOUTH TION <br /> Illustrate or Describe Distance of Well from Landmarks .—... OTHER(Specify) <br /> such as Roads Buildings Fences Revers etc <br /> PLEASE BE ACCURATE G- COMPLETE <br /> I DRILLING <br /> METHOD U4�r FLUID �� T <br /> WATER LE EL & YIELD OF COMPLETED WELL <br /> DEPTH OF STATIC rZs 7Y <br /> WATER LEVEL (Ft) & DATE MEASURED <br /> ESTIMATED YIELD (GPM) & TEST TYPE <br /> TOTAL DEPTH OF BORING D(Feet) TEST LENGTH (Hrs) TOTAL DRAWDOWN (Ft) <br /> TOTAL DEPTH OF COMPLETED WELL _(Feel) 'May not be representative of a well's long-term yield <br /> DEPTH CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE BORE ,yPE FROM SURFACE TYPE <br /> HOLE — INTERNAL GAUGE SLOT SIZE <br /> DIA W �_ <br /> MATERIAL/ CE BEN FILTER PACK <br /> Ft to Ft (Inches) g =— ` DIAMETER OR WALL IF ANY <br /> ' o GRADE MEN7 TONITE FILL <br /> � H c,o � (Intoes) THlCKNES5 (intoes) Ft to Ft � J � ("fYPEr51ZE) <br /> l0 1/GkA <br /> x l Ll ,�� 1 If <br /> IS v <br /> i <br /> ATTACHNIENTS (!) CERTIFICATION STATEMENT <br /> LGeologic Lag I the undersigned Certify that this report Is complete and accurate to the best of my knowledge and belief <br /> p L ,, ,f ��,, k t y <br /> Well Construction Diagram NAME =l�L-`•^�-� Pry;✓�T� I G w/`t (”`rt`1"'L l V � L)C"Lt s <br /> (PERSON FIRM OR CORPORATION))(TYPED OR PRINTED) ! <br /> Geophysical Log(a) Q J V —�.1GE t isv: a_ ` [V(� [_ W Y4 C r 1 `i S 6 ZC� <br /> OtheSolt/r <br /> Water Chemical Analyses �• CITY STATE Wim.�x <br /> ADDRESS <br /> Other <br /> ATTACH ADDATTONAL 1NFORMA7TON IF!T EXISTS SigC 57 LICENSE NUMBER <br /> nod fV� l �'���Q!6 — ��Ek A <br /> WEi! I)RELLER/ E DATE StCNED <br /> D%R Inns Rte 7'w IF ADDITIONAL SPACE IS NEEDED USE; NEXT CONSECUTIVELY NUMBERED FORM <br />