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ORIGINAL ST ll t= OF ( if Ir(Hi 41A �— OWA USE ONLY DO NCY FILL IN <br /> File with DWR N LL COMPLETION REPORT) i I f 4 1 1 1 I I 1 1 � <br /> P_tgC 1._raj h,r,r to ("two'." 1'rfit uhlr t STATE WELL NO,STATION NO <br /> t�nn�l s i)etl �tl MW-. NO n <br /> D ik [[,)ti, BQ�,ul �% ,/? / Bndecl i+ .w LATITUDE LONGITUDE <br /> Sats TQa,"„ n r~ ,,,>,+ <br /> l -p„ <br /> fDCttllC �leiiuit I I I APNIITRSIOTHI ER Date- 1 —01 <br /> I I I I <br /> I <br /> GEOLOGIC LOG WELL O�4VER <br /> ORIENTATION (i) �VERTICAL _HORIZONTAL _ANGLE —(SPECIFY) Nallie <br /> DRILLING <br /> DEPTH FROM METHOD FLUID lvfuhttg kcldiess2 00 Cl a�ton Rd, �,trte, 3 7�{� <br /> SURFACE DESCRIPTIO\ _r_nnnn-rH _ CA 9.4520 <br /> Ff .a Ft De ser(l.PL 1Nut(.,ad CI-zirriTY <br /> [ ( f . STATE ZIP <br /> [vLL I ocJTlaN <br /> �cicll e5s <br /> Couch 9-c'in _,Tnag1I i n _ <br /> a rk,1 w , c,fes] CL1P�t Book P Lge %t Parcel_ L l <br /> ' ' <� r , '~�' , a.s� TONvilsInp Range Section .,....__ <br /> L ttLtude i I NORTH Loumtlule t I WEST <br /> i DEGMIN SEC DEC, AKIN SEC <br /> Lf}CATION SKETCH ICTI't ITY (=} <br /> NORTH _ NEW WELL <br /> See attached Site plan. MODIFICATIONIREPAIR <br /> Deepen <br /> r , — Other(Spec,ty) <br /> DESTROY(Oescr(6e <br /> i i2mcedaras and Matenals <br /> Under GEOLOGIC LOG ) <br /> PLINKED [)SES {,) <br /> WATER SUPPLY <br /> Domestic _ Public <br /> irrigation _ Industrial <br /> LU MONITORING <br /> TEST WELL <br /> ' CATHODIC PROTECTION <br /> r I HEAT EXCHANGE <br /> DIRECT PUSH_ <br /> INJECTION <br /> VAPOR EXTRACTION �.�. <br /> i SPARGING <br /> r , SOUTH REMEDIATION <br /> (fhrst,dtc of D(suthc DAmilct of Wcll fr(rrnt Rands 81111filii-s <br /> r i F(R,^ RUCIN ,tc rn d(r(tach a❑roll Ls( tddrttonal L,dp,�t tf OTHER(SPECIFY) _ <br /> ucurtdril PLE LSE BE ACCURATE c;COIIfPLETE <br /> I , <br /> IV3,TER LEVET, & YIELD OF COMPLETED [VELL <br /> r , DEPTH TO FIRST VVATE9 (Ft) BELOW SURFACE <br /> i DEPTH OF STATIC <br /> WATER LEVEL (Ft)&DATE MEASURED <br /> ESTWATED'YIELD (GPM) & TEST TYPE - <br /> rOT',l DEFTIl OF i3()hl\C � �.� I'Cc[}l TEST LENGTH (HrsI TOTAL DRAWDOWN (Ft} <br /> TOT[[ DI-17T7 01 t OMPIETED CLL 5_S ^�tFert) Ifety not be Iepi etentatrte of a - ells lova-tclyn prel(f <br /> DEPTHBORE CILSING (S) DEPTH tNVUL 1R \I�►TI RIaL <br /> FROM SURFACE HOLE TYPE t T I FROM SURFACE TYPE <br /> DIA Y MATERIAL 1 INTERNAL GAUGE SLOT SIZE CE BEN <br /> Ft WFt I1h irnchas) q. d W J GRADE DIAMETER OR WALL IF ANYFILTER PACK <br /> MENT TONITE FILL <br /> m �? (Inches) THICKNESS Orichesl Ft to Ft (TYPE/SIZE} <br /> w L Z INA V j <br /> rd <br /> UJ I <br /> ' I I <br /> r � <br /> 1T17ICIII(ENCS CEIITIrIC\TION ST)LCEN(I:NT <br /> 1 the unaersigne❑ certify that this report Is complete and accurate to the lest of my knowledge and belie€ <br /> aeaogrc Log <br /> Nell Construction Diagram NAME [ F, TA 3 1.] T Tl T1 _ <br /> f _ Geounvsical Log(s} 4PERSCN rdRM JR IARPCRArvit JYPEO PjincokC <br /> 3 <br /> Sod/Water Chemical2naiyses PO BOX 416 Isletori, CA 95641 <br /> Omer ,3 ,.�l.rL �ORESs LITY r STATE _Ip <br /> _TT-U-- -001i'ONAL 1NF0F,41ATCN F IT t�ISTS Sigma _ 7� C �2 <br /> _ II/EL)`=EPRF�,� OA(E `'IG(!FD It,CNSE iIUPARER <br /> IF ADDITIONAL SP<E 1S NEEDED USE NEXT CONSDCUTtVEL t NUMBERED FORM <br />