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DwR USE ONLr — ❑o NOT FILL VN <br /> ORIGINAL STATE OF C\L IFoR\t 1 <br /> File With DWR WELL COMPLETION REPORT STATE WELL NOlSTATION NO <br /> PL< e�.._of� R(Ir, ro Insr+nitu,il Prn+ll,hlcr ❑ <br /> 0%vnes s 1Vell No MW r O No 04029 LATITUDI l� LONGITUDE <br /> Dak B(-rITan e !7 Ended <br /> Lnc,tl P Inut \r,enPublic <br /> L% an Joe uin coon Health AVN itHhWlHEP <br /> Petintt 1n 0026237 Peiinit Date 5-1 -01 <br /> GEOLOGIC LOG WELL OGVNER <br /> Oil <br /> ORIENTATION (t ) —.Y-VERTICAL _HORIZONTAL —ANGLE �_(SPECIFY) �I Mlle Exxonb <br /> il <br /> DRILLING FLUID 4latling ALC1L11ess <br /> DEPTH FROM METHOD <br /> SURFACE DESCRIPTION CITY STATE ZIP <br /> FI to Ft IJLSc 1 rl�e IlLutc I trrl <ficlill etZc 00101 Ltc WELL LOCATION <br /> l.( L11505 -q - E1 T-)arado , qt-reet <br /> t�ZC1 101011 ess <br /> Cit\ <br /> i`1 a Count" �� � l--7 <br /> 3 <br /> t 1V ' ��• ] �Pf Book Page PIrcel <br /> IS <br /> TolviTshlp Range SectlOtl <br /> I NORTH Lonuatucle I I WEST <br /> i LatltllCle DEO MIN SEC DEG MIN SEC <br /> LOCATION SKETCH YCTIVITY (zL) <br /> NORTH NEW WELL <br /> I i See attached Site plan. MODIFICATIONlREPAIR <br /> — Deepen <br /> i — Other(Specify) <br /> i I <br /> DESTROY(Describe <br /> t I Procedures and Materials <br /> Under GEOLOGIC LOG ) <br /> PLANNED USES (�) <br /> WATER SUPPLY <br /> Domestic — Puolic <br /> Irrigation — Industrial <br /> F_ <br /> Co ¢ MONITORING <br /> Lu <br /> w <br /> TEST WELL <br /> CATHODIC PROTECTION— <br /> I I HEAT EXCHANGE— <br /> + l DIRECT PUSH— <br /> I INJECTION <br /> VAPOR EXTRACTION— <br /> SPARGING—� <br /> SOUTH REMEDIATION...� <br /> I tlllotl(It,,(,l DCC 4 j I& L)Btrf"CL Of\S1Lll f ivill X7[![71 �r111LhlItiS OTHER(SPECIFY)- <br /> Flnccs llraus &C raid uttnLlt n u,app Vs'ndrhtlowd trape+ +f <br /> ucclssary PLEASE BE ACCURATE L-COAfPLETE <br /> NATER LEVEL & YIELD OF COMPLETED WELL <br /> DEPTH TO FIRST WATER (Ft) BELOW SURFACE <br /> DEPTH OF STATIC <br /> i + WATER LEVEL (Ft)&DATE MEASURED <br /> I I '� ]'�y�, ESTIMATED YIELD (GPM) & TEST TYPE <br /> FOTU DL-1'"111 OF SO)RINC' L-)&F(ct) TEST LENGTH (Hrs) TOTAL DRAWDOWN (FI) <br /> r0T U DC11 rll of I 0\1111 ETTD 1\ELL �'Fcrt> llav loot UL I epi ueruau,e of(t--ell'I rb,77-te7'1tl }Alii <br /> C 1SINC (S) DEPTH ANNULVR MATERIAL <br /> DEPTH SORE FROM SURFACE TYPE <br /> FROM SURFACE HOLE TC!L)DIA ERIAL 1 INTERNAL GAUGE SLOT 512E CE ON11(Inched RADE DIAMETER OR WALL IF ANYMENT TONIFI to Ft ((nches) THICKNESS (Inches) Ft o FtXL. O <br /> 611 <br /> C. <br /> I <br /> i <br /> r —�— 1fTIGII\IL�iIti fes} CURTITICITION ST,aTENIENT <br /> f I the undersigned certify that this report IS Complete and accurate to the best of my knowledge and belief <br /> _ Gealaglc Log <br /> Well Construction Diagram NAME V & W Dr i 11 In Zn <br /> SPERSON FIRM OR CORFORATIONI (TYPED OR PRINTED) <br /> Geophysical Log(s) PQ Box 416 I s l e ton CA 95641 <br /> Sod/Waler Chemical Analyses CITY r STATE LIP <br /> .0ORE5S j <br /> Other <br /> �l-TAGrI.1DDfrfONAL NFOAfviA�lON 1F I7'cXISTS Signed , DATE TIGNE9 f it LkGENSE iNMBEfl <br /> ,TELL ORILLERI'A FHORITEO REPiiLSENTATI4E <br /> ui l I IF ADD4TONAL SPACE 'S NEEDED USE NEXT CONSECUTIVELY NUMBERED FORM <br />