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ORIGINAL <br /> ST1TC OFF C\UFOR\lk DWq USE ONLY — 00 NOT FILL 'N <br /> 1`re <br /> File with th I7Wp ' RT'ELL COMPLETION REPO <br /> i� [7f „_ Ike r�r t, 1ratrfir rrrn PrrrrrplFht STATE WELL NO STA 0N�NO <br /> 5 <br /> Lr«nct Zj elt Nu _MW6, -7 ; A r) <br /> `)1rc 11 rn!. Be,u� `" D ] � <br /> ;IiCeCLATITUDE <br /> LONGITUDE <br /> Lt>L it I'�it)l t �,ei)L� Yl oa uin Count Public Health I <br /> Pei nut �o0026236 Peimit Date 5-1 -01 L iHnu I Hb,U I HER _ <br /> GEOLOGIC LOG «'ELL OPV\TER <br /> ORIENTATION {�) VERTICAL _,iCRIZONTAL _ANGLE —(SPECIFY) \aine ExxonMobll 011 Corparat1on <br /> ORILLI`JG <br /> DE--TH FROM METHOD FLUID \I u1Ln; -Wdress 2300 Cla ton Rd . s t e. 1250 <br /> SURFACE DESCRIPTION ConQQrd, CA 94520 <br /> Ft to R D,5(i it)[ mcrtcl ifd 1 Alii sl-cc UIol c tc CITY STATE ZIP <br /> ralWELL LOCATION <br /> lddiess _C'cc±nt r Strcztz <br /> c�i r CID Citv <br /> County _ ;a n Ton cE117T_ <br /> ` C kPv Baol. P <br /> Talvnslul� Ranke Section <br /> Latitude_ 1 I NORTH Long WEST <br /> I WEST <br /> ' DEG MIN SEC DEG MIN SEC <br /> LOCATION SKETCH YCTIA ITI (�} <br /> i r NORTH _ NEW WELL <br /> I i <br /> See attached site plan. MODI FICATICN/REPAIR <br /> ____ Deepen <br /> Other(Specify) <br /> i r <br /> r i DESTROY{Describe <br /> PmCedures and Mafenals <br /> I Under GE=OLOGIC LOG ) <br /> PLaNN*ED USES (�) <br /> WATER SUPPLY <br /> ' Domestic _ Public <br /> I i Irnganon _ mousrnal <br /> w j <br /> I 3w MONITORING <br /> TEST WELL <br /> CATHODIC PROTECTION_ <br /> ' HEAT EXCHANGE <br /> ' DIRECT PUSH <br /> I r INJECTION_ <br /> r r <br /> VAPOR EXTRACTION <br /> SPARGING <br /> f SOUTH REMEDIATION <br /> 111ustratc or Deso I&DI5tfl1ILC,rt Wdl lrmn Road% '3wIdnrSs <br /> ' I Firsts RutrP ate rind attach If Ilia)) C%rtddttlunrcl pn)Rrf} OTHER(SPECIFY) <br /> neccssa)ll PLEASE BE -1CCLI{ATE&C011PLLTE <br /> WATER LEVEL ,`;t YIELD OF COMPLETED WELL <br /> ' I DEPTH TO FIRST WATER (FI) BELOW SURFACE <br /> ' I DEPTH OF STATEC <br /> WATER LEVEL (Fl)&DATE MEASURED <br /> ESTIMATED YIELD (GPM) & TEST TYP <br /> Lr())11 <br /> I]rl'TII f)� l3S)RI\C, �(Fcrt! TEST LENGT(-I <br /> (Hrs) TOTAL DRAWDOWN (Ft) <br /> ) <br /> I)EPT11 I)t' (MIPf CTM %ELL X65` it7uet ' lIu) rtorGe reFrcreretntltr of a e!l' lorl?-terrir ylelcl <br /> DEPTH SCRE- CASING (S) DEPTH kNNL'L\R NIATERIA.L <br /> FROM SURFACE HOLE TYPE( . ) FROM SURFACE NPP <br /> DIA Y w ,p a MATERIAL! INTERNAL GAUGE SLOT SIZE <br /> (Inches) w a CE BEN FILTER PACK <br /> �1 a FI a x o� GRADE DIAp,AETEq OR 'NALL 1F ANY MENT TCNITE FELL <br /> (Inches) THICKNESS (Inches) Ft to Ft (TYPEISiZE! <br /> ,iC <br /> I <br /> , <br /> 1 rr 1{ 11�tLNTS I �) CCRTIF[c moN ST lrEMEN'T <br /> I the undersigned Certify that INS report Is Complete and accurate to the Lest of my knowledge and belief <br /> Geologic Lag s <br /> r <br /> Well Construction Diagram NAME <br /> Geophvslcal'o9 i J s (PERSON HRM SJR .0RPORATIQN) (TYPED OR PRINTEDI J <br /> _ <br /> SodlWatar Chemical Analyses r�lt— <br /> r <br /> . Other t r.J ' j ADDRESS rITY aTATE QIP <br /> L (� _ <br /> i1 i ar�rf JDDJTIL'NAL IrVFOftMATION F fT={!S7-j $ignerl � t—� .' � / � (�J`t rJ <br /> /AIJTHCRI�Ep <br /> REPRESENTATIVE DATE 31GNEO i r lICCNSE JUMBER I <br /> n1I I' " ,' IF ADDITIONAL SPACE IS NEEDED USE NEAT CONSECUTIVELY NUMBERED FORM <br />