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' DWR USE ONLY — DO NOT FILL IN —' <br /> QUADRUPLICATE STAT€F 0P C.AI INURNIA <br /> For Local Requirements WELL COMPLETION REPORT <br /> b of Rif r to ItiQruahon Prnnp�hdct STATE WELL NO/STATION NO <br /> O-.vne� l No <br /> VelNo ?O <br /> LATITUDE LONGITUDE <br /> 11"" <br /> Date `�tOYlc I3Cg�i11 w � I�n(1C(1 <br /> Lo(ll PGI nllt AC;nCVjeaqUin <br /> APNITRSIOTHER 1 <br /> Peirlut No OVSHe Pelnut Mte 8/5/98 <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION (✓) _1(—VERTICAL —HORIZONTAL —ANGLE _(SPECIFY) Name <br /> DRILLING Mailing Address DEPTH FROM METHOD FLUID 0 <br /> SURFACE UL;SCRIPTIOI\ <br /> Rt to Ft D&v ribr IRntc ria! gram sl2( (olot (tf CI faa Ramon STA IP <br /> WELL LOCATION <br /> 0 518 -outed with neat! VrQueuve grAc retiti <br /> 1347 south 91 Dorado Strevat <br /> 46mento UP 5 feet of casing Glty <br /> ' County <br /> APN° AooL Page P ircel <br /> ' Towntilup R angc Section 7 <br /> Latitude I I NORTH Longltu ClC I I WEST <br /> i I DEG MIN SEC DEG MIN SEC <br /> LOCATION SkETGH ACTCVITI (_t:L) <br /> NORTH <br /> NEW WELL <br /> I <br /> MODIFICATION/REPAIR <br /> I — Deepen <br /> 8ee map• _ Other(Specify) <br /> DESTROY(Describe <br /> Procedures and Materials <br /> Under GEOLOGIC LOG J <br /> PLANNED USES (�) <br /> I , WATER SUPPLY <br /> Domestic Public <br /> Irngaticn Industnal <br /> w 4 MONITORING <br /> 3 w <br /> TEST WELL <br /> I CATHODIC PR07ECTION . <br /> HEAT EXCHANGE <br /> Y I I DIRECT PUSH <br /> INJECTION <br /> VAPOR EXTRACTION— <br /> I SPARGING <br /> SOUTH REMEDIATION <br /> 1111stlatc or 1),scribe Distance of waifoom Idnarls B,ulrhn�e <br /> Frrurs Rirt+s ,tc and attach a final ZAi addrlitnml 7ta)tr+ +f OTHER(SPECIFY) <br /> nrrt sst+r rl PIFASF BF ACCURAfil &COAIPLLTL <br /> WATER LEVEL & IIELD OF CONIPLETLD FIE1 L <br /> DEPTH TO FIRST WATER (Ft) BELOW SURFACE <br /> i DEPTH OF STATIC <br /> WATER LEVEL (Ft)&DATE MEASURED <br /> I I <br /> ESTIMATED YIELD (GPM) & TEST TYPE <br /> TOTAL DEPT][ OP flomv (p(et) TEST LENGTH (Hrs) TOTAL DRAWDOWN (Ft) <br /> TOTAL DEPTI{ OF COMPLETED WELL (Feet) May not be replejentative ofa uell'.rlong-tes-n yield <br /> DEPTHBORE CASING (S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE HOLE TYPE O:) FROM SURFACE TYPE <br /> DIA Y w a MATERIAL I INTERNAL GAUGE SLOT SIZE CE BEN(Inches) .�Z-j <br /> - a GRADE DIAMETER OR WALL IF ANY MENT TONITE FILL FILTER PACK <br /> Ft to Ft Ft to Ft TYPElSIZE <br /> M c» (Inches) THICKNESS (Inches} ( ) <br /> , I <br /> I <br /> ATTACH NI EN TT(2L) CERTIFICATION STATEMENT <br /> Geologic Log ! the undersigned, certify that this report is complete and accurate to the best of my knowledge and belief <br /> — <br /> — Well Construction Diagram NAME PaeifiC Rnytronmential Qrc)Up. T>nr__ <br /> )PERSON FIRM OR CORPORATION) (TYPED OR PRINTED) <br /> Soil/Water Chemical Analyses <br /> Geophysical Log11315 Sunrise Gold Crop Ste, Mf Ranco Cordova$ CA <br /> — <br /> Other ° ADDRESS 1 CITY STATE ZIP <br /> ATTACH ADDITIONAL 1NFOAMATION tF)T EXISTS Signed t d + DATE SINNED C 51 LICENSE NUMBER <br /> WE DRILLERlAUTNORIZED REPRESENTATIVE <br /> D11R ISS 11 E1 11 97 IF ADDITIONAL SPAC IS NEEDED USE NEXT CONSECUTIVELY NUMBERED(FORM <br /> J <br />