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U <br /> 'The bee Adobe Reader may be used Io View and complete this form. Huwever,soRxsre must be pl <br /> perClMed ID Oam ele,Saye,and mUee a Saved forth. <br /> File Original with DWR State of Calilornla OWR Use a—Do NFD In <br /> Page of I Well Completion Report i, - + <br /> Owners ' MW—9 Rekrro aurnwaa vapver I <br /> Well Number NO. 095499 Slate Wee NumbeNSile Number l <br /> Date Work Began S 2 20Q0 Dale Work Ended 23 20 W <br /> LetiNde Lon rude <br /> Local Permit AgenY r CAV, <br /> Permll Number s' DiS7777 Pelmfl DaleIt2009 J APNrtRS/Dlher <br /> Geolo is Lo - - Well nor j <br /> Orientation Vertical OHorizorllai OArlgle Spacdy Name PMNI OLr Ir <br /> Drilling Method ()I cM!S Drllag Fluid N <br /> Depth from Surface Description Mating Address ZZ Z fAtO ll e146V I <br /> xll. ,. Feel , ,a. Feet Describe material rain size color do CII WC4 [^ Slate 71 9S3 <br /> Well Location -� <br /> ('S Address <br /> City_ I �} County NO" <br /> h cols Latitude —+__ N Longitude_—_yp <br /> . Deo.-• Alb. sec Dee. Min. sec <br /> AAAd AG 4- 'C rUrtW1f Datum— Deamal Lal TJ 7,7 0 Decimal L (? *7 <br /> �- 4+ <br /> APN Book 7.7 Page W 3 <br /> Cyam( Townshi Ran12Section <br /> Location Sketch Activit !I! <br /> I sLea,a,xmaraen Id aflerbm,m ONew Well f <br /> North O ModificationrRepalr <br /> 5 Nir O Deepen <br /> O Omer <br /> leslroy 1[r{ <br /> Planned Uses <br /> O Water Supply <br /> 3 y QDomeatic OPublic <br /> 3 _ L44'1 U ❑irrigation ❑indusldal <br /> O Cathodic Protection <br /> O Dewatering v <br /> O Haat Exchange <br /> 0Injection <br /> . O Monitoring 1 <br /> -. O Remediation <br /> Eq S <br /> it , ' ^�I O Spanglingest i <br /> South <br /> o.vti,ea�ea.se.wa..+w.eA.a,.eas,oc O Vapor Extraction <br /> mos.aewseamewa u.e.erab.leweaneoe,s.r. O Other <br /> Vlw,b�svw W an <br /> Water Level and Yield of Completed Well <br /> Depth to Fast water (Feet below surface) <br /> Depth to Static <br /> Weser LevelQ (Feet) `Dale Meared 23 <br /> Total Depth of Boring Feet Estimated Yield su <br /> (GPM) 'Test Type <br /> Total Depth of Completed Well l Feet Test Length '• (Hours)Total Drawdown_(Feet) <br /> I'May not be representalkne of a well's long term ' 1d. <br /> Casings Annular Material <br /> Depth from Borehole Typo Material Wall Outside Screen Slot Slze Depth from ,r <br /> Surface Diameter Thieknass Diameter Type if Any Surface Fill Description <br /> Feel b Feel Inches Ir cho. Inches Mhos Feel b Feel <br /> K <br /> Attachments , Certification Statement i <br /> ❑Geologic Log 1,the uM�e�sign�ed,c�g�rd Mal Ihl�repwt I5 cpmtte,and accurate to tha best of m knowledge and belief <br /> ❑Well Construction Log on Diagram . Name ndV:n_td__fy;N J/O�eli 5ff Y / <br /> ❑Geophysical L IS 4 D on Sipe oScgi j " N M S!. _/0� CA '7SZ�QS <br /> Log(s) cV N � 17 0l <br /> ❑SoIVWaler Chemical Analyses /, /�� my scam <br /> ❑Other Slgnad�U�Ya 's.s f7 WFS -fl?qtdl 36301 <br /> AtlaN eEaieorul Homm r aarummeewemrwacaweav Dale Signed C-57 License Number <br /> DwR IN REN.foods a ADonIONAL SPACE IS NEEDED,USE NEXT CON9ECImNEiy NUMBERED FOFM 1 <br /> sFi <br />