Laserfiche WebLink
i I <br /> 'The bee Adobe Reader ma be used to viewantl �I <br /> Y Template N§loan Fbwever,soRware must be purrAased 10 OMM ale,save,and rens¢a saved form <br /> File Original with DWR Slate of California =�NrFRSIOQ, <br /> On -DO Na FA In <br /> Page�_ of Well Completion ReportF Ti <br /> Owners Wall Number M ^ Rebrloar In paarvaelNo. e0095493EDate Work Began 2 0 II!Date W Ended 2.3 20 � 1JLocalPermitAgency .p KI �PemulNumber S2VN7777 PermitDale or <br /> Geolo Ic Lo <br /> Well C nor 1 <br /> Orientation Vertical OFtodzDidat OAngle Sped Name I 5 GO 4 v <br /> DAliflg Method- OnlUng Fluid <br /> Depth from Surface ?-2-9 Maeir+q'�pddrens' ZZ L2- 76taIC1.MAe- <br /> Feet to Feel -..,.Describe materialwain size,color etc 1Cj!XJ-war11A A�t V7- Stale c-/t �i., 2S�Gl3 <br /> Well Location _ -- <br /> wcut w Address ` rr <br /> S County City L / SyG(/ <br /> V111 cA5tV -� <br /> Latitude N;Longilude w <br /> Dasa let Sec a.. Mit Sec <br /> C*-I 11 " Dv2 Dam Decimal Decimal Lon;.121.4t(7 <br /> APN Book 2.3 3 Page 37 Parcel 00 3 <br /> W i Tovmsh' Ra a Section 1 <br /> Location Sketch ACUvIt <br /> tp-t D sw.Idl moetea saes nam dNrbrin b New Well <br /> rtodh <br /> O ModificationfRepair I <br /> $ - O Deepen <br /> 17 AU to OOther <br /> XDestmy <br /> asaoe Po.o..em..a,aa <br /> wn�ccacmclar <br /> (y Planned Uses <br /> 'I p O Water Supply <br /> ❑Domestic ❑Public <br /> [Irrigation ❑Industrial <br /> i N O Cathodic Proloc110n <br /> L tt�All <br /> _ I I` O Dewatering _f <br /> O Heal Exchange <br /> - .7 01n)eotion <br /> f(I(W_ /+ O Monitoring <br /> } O Remerxation <br /> pg f 'I!1 *� S f 4 Qe f O Sparging <br /> .. �i O Test Well <br /> s.e.e maeaaeerweN..aee.imhs+drvt ram. O Vapor Extraction <br /> 2ma m.aami...q.u.mruw Pvrzrm.y. O Other <br /> n...ea.a...N.�e <br /> Water Level and Yield of Completed Well <br /> Depth to first water (Feet below,surface) <br /> Depth to Staec <br /> Water Level r d ' (Feet) ,Dale Measured 7�2-3IO9 <br /> Total Depth of Boring Feet Esfimaled Yreld• �(GPM) Test Type <br /> Total Depth of Completed Wel — Feel Test Length (Hours)Total Drawdown (Feel) <br /> 'Ma not be it Malive of a welts to term 'end. <br /> Casings Annular Material <br /> Depth from Borehole Wall Outside Screen Slot Size Depth from <br /> Surface Diameter type Material Thickness Diameter Type IIAny Surface Fill _ Daacdptlen ' <br /> Feel ro Feel Inches Inches nchas nches Feel b Feel <br /> 7{{ <br /> 1 <br /> F <br /> Attachments Certification Statement <br /> ❑Geologic Log Nthe <br /> mound sign C q SDy Ih�al Ihisteport Is oo loto and accurate to the best of my knowledge and belef t <br /> ❑Well Construction Diagram, J <br /> ❑Geophysical Logs) 2-5 co`9-t .C Vg wNdr. S ]�M CA 9 S Zo 5 <br /> ❑SolUWater Chemical Analyses Add.Mcar stere <br /> 13 other Signedcw+paelM.e,ini4.w�-s/p✓P.�.;S�(,V� 7/Zv{o G 3G 3f 7 <br /> Nladl eaSdontl lraorine Ynomla. osrumr.edwelarwa Coavauv Dale Sl ed C-571-1cense Number I <br /> awR IBB REV.18006 nF AOCHI SPACE IS MEMO.USE NI OONSECUDJE].Y WMeEREe FORM <br />