Laserfiche WebLink
ORIGINAL STATE OF CALIFORNIA U11 ! <br /> "*with DWR WELL COMPLETION REPORT STATE WELL NQ/STATION Na <br /> ����of � Refer to lnrtrncrron Pamphlet ❑ ❑ <br /> qe.!,�A,Ork <br /> rWell No u�- "� 5 3 3 3 5 0 <br /> meq.. LATITUDE LONGITUDE <br /> Began Ended `f _� -� <br /> I Permit Agenc r <br /> 1 S <br /> Permit No Z Perm)t Date <br /> GEOLOGIC LOC W LL WNER <br /> ORIENTATION {�) A VERTICAL _^ HORIZONTAL — ANGLE — (SPECIFY) Name � � <br /> FR DEPTH TO FIRST WATER (FL)BELOW SEIRFACE h1aili g Add r <br /> 10 <br /> Dst DESCRIPTION CITY STATE <br /> ZIP <br /> FI to Ft Detrnbe rna:mal,!(rain trze color etc E L �OC T NZZ <br /> Address <br /> 1 1 Q a 1N'1i a,�l City <br /> ' County <br /> „( yr <br /> t �- 9 Parcel. --ti <br /> C"Al N Book Page <br /> ts� Or <br /> 'fOw« P Range be <br /> 1 rislii (.tlun <br /> WEST <br /> r V46 Latitude N0F1TM Longitude_DEG MIN SEC <br /> 1 DEG MIN SEC <br /> 1 LOCATION SKETCH ACTIVITY f�) <br /> ' NORTH _ NEW WELL <br /> 1 <br /> 1 MODiFICATIONiREPAIR <br /> 1 <br /> —_011ier(Specliy) <br /> 1 <br /> �- <br /> r r S� DESTROY{D*acnw <br /> O Procedures mtl AlareruU <br /> 1 y / SS tlntlw GEOLOGICLOG) <br /> b r- PLANNED USE(5) <br /> W <br /> W p { ) <br /> �. MONITORING <br /> r <br /> WATER SUPPLY <br /> Domestic <br /> 1 <br /> Public <br /> 1 1 <br /> Irrigation <br /> i <br /> � Industrial <br /> TEST WELL <br /> CA7HObIC PR07EC <br /> SOUTH TION <br /> illustrate or Describe Distance of Well from Landmarks <br /> OTHER(Specdr) <br /> such as Roads Buildings Fences Rivers etc <br /> PLEASE BE ACCURATE & COMPLETE <br /> DRILLING FLUID <br /> METHOD <br /> WATER LEVEL h YIELD OF COMPLETED WELL <br /> DEPTH OF STATIC <br /> 1 1 WATER LEVEL (Ft) & DATE MEASURED <br /> ' ESTIMATED YIELD* (GPM) d TEST TYPE <br /> TOTAL DEPTH OF BORING fFeet) TEST LENGTH (HrsI TOTAL DRAWDOWN (Ft) <br /> TOTAL DEPTH OF COMPLETED WELL (Feet) 'Mav nor be representative of a wells long-term yield <br /> Ck51N,G(S) jDEP 4NNULAR %ATERIAL <br /> DEPTH BORE ACE TYPE <br /> FROM SURFACE HOLE TYPE ! <br /> DIA x a MATERIAL! INTERNAL GAUGE SLOT SIZECE BEN FILTER PACK <br /> pnchea) < x� d GRADE DIAMETER OR WALL IF ANY MENT TONITE FILL <br /> Ft to FI m <br /> (inches) <br /> THICKNESS (Inch**) Ft (� ) (� ) (� ) (TYPE/SIZE) <br /> N <br /> 1 <br /> 1 <br /> 'ATTACHMENTS -CERTIFICATION STATEMENT <br /> I the undersigned, certify that this report Is complete and acCurate to the best of my knowledge and belief <br /> Geo"Ic:Loa /(�Y_`!/l_ <br /> Well Construction Dlagrern NAME Dq CQRP WATIDN) (TYPED R PRINTED) <br /> (PE <br /> Geophysical Luq(s) yS1 J C.C�R� / W�+ �y_• V f ! R <br /> SoRlWater Chemical Melyaea ADDKESS CITT STATE 2(P <br /> -- other <br /> Ar'rACF!ADOITlOAfAL NJFORMATJpN fF rr EXISTS (tailed DATE IGTiED C 57 LICENSE NUMBER <br /> tMl pRILLER IUITt16RIZED REPRESENTATIVE <br /> uccnrn tlac WVVT rnmgprllTIVELY NUMBERED FORM I U 01 <br />