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"9he(fee Adobe Reaper may be wed to view and complete this(am However,software must be purchased to complete,save,and reusaesaved form, <br /> File Original with DWR - State of California <br /> DWR the On -DO NoI Ftl In <br /> Page or I /' Well Completion Report <br /> Owners Well Number W^(p Kram 00954 Pa"a"e1 Slate Wetl NumbedSite Number <br /> Dale Work Began Z No. e0095492 <br /> q Date W rk En d <br /> l.oml Penna Agenry S r '_� LaynMe Lt--�— <br /> PermitNumbers 7 Permit Dale 9 APN/IRS/ODrer <br /> Geologic Log I <br /> Well caner <br /> Orientation Vertical QF{a(zonfar OAngle Specify Name s COX v <br /> Od9log Method ! ULV �.(.. Drllll FMd Al r� i{ <br /> Mal9n AdMess Z Z. T <br /> Depth from Surtace - Descri flan 9+�, I <br /> Feel r Feel Describe material Iil - . Ci —f-Wldl�Ll /A[�' etale <br /> Well Location i <br /> w" Address °S9S R I[f <br /> City County / <br /> Latitude 'l N'Lorgitude <br /> Oro.. Nn Sec r',. pea. Eye� <br /> e Delum�� Decimal Lal.g7i 7� Decimal Long.(2l Lf/7 <br /> APN Book G a J page 37 Parcel 003 <br /> 49N?", Townshf Ra a Section - �l <br /> Location Sketch Activity <br /> le / stem,mala a�avm nem anxramrIF <br /> New WeB <br /> NOWO - O Modillm tonlRepa5 rO Deepen <br /> O 011ier <br /> DestroyPlanned Uses t <br /> Water Supply <br /> ❑Domestic ❑Pubic <br /> 3 ❑IRigation ❑Industrial <br /> O Cathodic Protection <br /> O Dewaledng <br /> a OHeat Exchange <br /> 0 Injection <br /> MW O Monitoring <br /> O Remediation <br /> (('l•f" Sf}eQ 'y O Sparging fi <br /> ,Sarah O Test Wen <br /> eaeseaamasr.oreasa.m.w.aasa.r.®, O Vapor Extraction <br /> t.+a en.r ra,ae.o.u.wwaae,s�w. O Other <br /> Water Level and Yield of Completed Well <br /> Depth to first water (Feet below surface) <br /> Depth to Static <br /> Water Level (Feel) izDate Measured Z3�✓ / <br /> Total Depth of Boring Feel Estimated Yield' (GPM) ;Test Type <br /> �A Test Length (Hours)Total Drawdown_(Feel) t <br /> Total Depth of Completed Wefi I"7 Feel *May not be remesentative of a well's long term ell. <br /> Casings Annular Material <br /> Depth from Borehole Type Matarkd en wall Outside ScreSlot size Depth from <br /> surface DiamOter Thickness Diameter Type if Any Surface Fill Description <br /> Feel b Feet Mies Indies Inches) flocheal Feel r Feet ' <br /> i <br /> Attachments Certification Statement n <br /> ❑Geologic Log I,the unde igrred,cgrlify That nits report Ispgmplate and accurate to the best or my knowledge and belief <br /> ❑Well Consuuction Diagram Name— IhQ_G/S(fM SrMAtA!!/ al- I' <br /> ❑Geophysical Log(s) 2 3 aa.FtmaW M iy Cf-t'DLl CA 9SLO S' <br /> ❑SoillWater Chemical Analyses _.I,.p ma. p��� ��� atr sur LP ) <br /> ❑Other Signed rA A *wk?l�A�?oismA 7 h g1V7 U 3G 307 <br /> Aluahmesawlaramm.s esus. carumneeawrxwesccoa Date Skined C57 License Number <br /> DWR tee REV.111006 FADVMO SPACE IS NEEUED,USE NFXr CDNSECIX(MLY NUMBERED FORM <br /> l <br />