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'The free Adobe Reader may be aged to view and compete this fort,,. Hmvevw.coaw,a must be rc and to rmn <br /> PU pale,save,and reuse a saved form. <br /> File Original with DWR Stele of California , l, f <br /> Page_� or _L Well Completion Report: - DWR Use -Do Net Fel <br /> RererbeM0lrtlonpenpwt .. <br /> Ownefs Well Number W `� No. 095 l f T—Stale—Woo NNanba M.Numb, <br /> Dale Work Began Z O`f Dale Work ndr � Z 3 Z/J0� La Lon <br /> co W <br /> Local Permit Agent19 Vk!g— M H V, to <br /> Pennll Number S Permit Date 2J 9 APNRg3lONer 1 <br /> Geologic Lo - •r Well ner If <br /> Orientation Vertical OHoriz tal OAngle ENa S Ari <br /> Drilling Melhed dung Fluid / ZL BfDZ N/ /NOIUR4NCq�za�Depth from Surface eeription Address + 2Feel a Feet Describe maedel n size odor.ate Stale I j <br /> Well Location 11 <br /> Address 5 Drs <br /> 1`PiVYi Vi 14 ry City 4 County S 01+1 NYI k <br /> Latitude _ N Longitude <br /> AA,%A 6C4M f1 DatumDoo. ase <br /> Door Decimal Sao. <br /> a. 3747Y-19 Decimal Long.IL/d*7 f <br /> APN Book 23 3 page �T 7 Parcel 0903, <br /> W I'VA ATownsM Ra a Raclin. <br /> Location Sketch Activit <br /> '� 1 steeA saatMaa+n haM dbrbmb Naw Well <br /> Nash O Modification/Repair <br /> 5 O.Deepen <br /> uuOOther <br /> NW.S qp Destroy <br /> Planned Uses <br /> O Water Supply <br /> _7 7 ❑Domestic ❑Public <br /> 3 w ❑hrigalion ❑Indusldal 'l <br /> O Cathodic Protection <br /> 0 Dewatering <br /> O Heal Exchange <br /> O Injection <br /> - ��y- O Monitoring <br /> a f I 5 ftrAeer O Remediation <br /> O Spaging <br /> South i• O Test Well <br /> . �+IxaoroN,wste,ur�+w,,,ms.meroee recta. O Vapor Extraction <br /> nxee wd.u,..,e.IN.saase„+r.+sarymaw O other <br /> ONa,+breww s.s <br /> Water Level and Yield of Completed Well <br /> Depth to first water (Feel below surface) <br /> Depth- static 0 tD (Feet) ,Date Measured 7f 23/09 <br /> Depth Level O <br /> Total Depth of Boring Feet Estimated Yield' `N (GPM) :Test Type <br /> Total Depth of Competed Well Fast Test Length (Hours)Total Drawdovm_(Feet) <br /> *May not be representative of a well's Iona term yield. <br /> Casings Annular Material <br /> Depth Iran Diameter <br /> Wag Outside <br /> amete Semen 31,SlrarDepthfce Sudae+ Diameter Type Metadei Thlekness Dl+meler type - IfAriydae+ : FIII � Da+cdpgon <br /> Fast b Feel ncMs Inches Inches Intoe+ a Feel <br /> ii <br /> I <br /> Attachments Certification Statement <br /> ❑Gedogio Log I,the under)pned cerlifv that this M Is complete and accurate fo the best of my knowledge arch belief <br /> ❑Well Construction Diagram ' Name — r Gr _r D'LL. 01 LVfl fLl°k <br /> ❑Geophysical Log(s) 23(0 'W i A Wa r, S-tvalp'LA ,c, 9520 9 <br /> ❑SoilfWaler Chemical Analyses aN stab a <br /> [3 Other �g�ed i G+f l '��kS/R2cdiu z O't 63630' <br /> .vl+rhaae+u,.levu+rm,y+„+,� Car txeaed wets,wd Con"aW Dale Signed C-57 License Number <br /> ORAS REV.V1006 FADDITKN SPACE IS NEEDED,USE NEM WNSECUINELY NUMBERED FORM <br />