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U yI <br /> V <br /> 'The free Adobe Reeder may be used to Kew and complete this loan Hwrevar,software must be prrc ased to ccmdele,save•and reuse a saved form. <br /> File Original with DWR Slate of California DW'H Use —Do Not Fill In <br /> Page—L .of Well Completion Report <br /> Kean IUYvaemen Paavr+er <br /> Owners Well Number —� No. e0095487 slate wee NumbedSse Number i <br /> Date Work Began 2-111 200'1 Date ak nded 7 2. 1 2009 ? LM.Uce N �i <br /> Local PermitAgen r <br /> Permit Numbers D57 7 permit Date 2009 APNrtRSlgher <br /> Geologic Log Well Owner <br /> Orientation erticall 0Horizontal OAngle Spxay Name Ic -Lt <br /> DrePolg Meulad M(,W5k4t.l Oduma l-Tula MatingAddress 2L (pZ P,::TU urNge <br /> Depth from Surface - Description E <br /> Feel to Feet Describe material, in size.DOWek Cil r� Slate i _S38 <br /> Well Location <br /> w- Address R ( <br /> City Iyzi,c4 L C./& County SoiM R } <br /> /•eWldVrbt Latitude NLangitude_�_yy <br /> den M"v Sec. 00. Asn Sec <br /> M eirM Datum Decimal LaL`17. 7 Decimal Long.(L(A ofi <br /> APN Back L3 Page 3 7 Parcel 00- <br /> ]a <br /> kl yQ.G41/`� Townshl Rena Section <br /> Location Sketch Activit ! <br /> SaeM•must ne darn nand dna,ra•mw 0New Well ! <br /> North O Modigpbon/Repair <br /> S O Deepen <br /> O Other <br /> MW I i; DestroyI <br /> werGaouxresoo- <br /> Planned Uses <br /> O Water Supply <br /> 1.,a+I WS ❑Domestic ❑Public <br /> 3 ❑irrigation ❑Indusbial <br /> O Cathodic Protection <br /> u O Dewatering <br /> .ii O Heat Exchange <br /> O Injection <br /> O Monitoring <br /> O Remediation <br /> O Spargirg <br /> South O Test Well <br /> ax»oe..00.au.,mN..waa.me..aays*a.w O Vapor Extraction ! <br /> nwae�. .mow u�a u•eee�,+o�en`�+ 0Other <br /> ater Level and Yield of Completed Well <br /> Depth to first water (Feet belay sudac I) <br /> Depth to Static / <br /> Water Level �•� (Feet) I. Dale Measured 717.4 III <br /> Total Depth of Boringapp Feet Estimate YieM�/ (GPM)+Test Type <br /> Total Depth of Completed Well Al/A - Feet Test Length (Hours)Total Drawdown_(Feet) <br /> 'May not be reoresenla We of a well's lovill term yield. <br /> Casings Annular Material <br /> Depth from em <br /> orehote Walt Outside Screen slot size Depth from 0 <br /> Surface Diaeter Tye Material Thickness Diameter Type If Any Surface " FIII Description <br /> Feel to Feel (Inches) Inches nches (Inches) Feel to Feet <br /> 1 <br /> --------------- <br /> ' 1 <br /> Attachments ! Certification Statement <br /> ❑Geologic Log 1,the undersf�netl cent(y 1flal thiSr! is corpplf ie and accurate to the best of my knovAege and belief <br /> ❑Well ConsWction Diagram Name r�'V��u-S1, 3GWHJ /FT'l2E t <br /> ❑ceophyalDalLog(:) 23tiSP ( 5"wAwi Qr, �fUc{c lA CA 95205- j <br /> ❑SoiWyater Chemical Analyses ,,rr��/7II ,I (� City &ace Zip <br /> ❑Other - Sigrledew7p( urn �wr U1 f.-�i�Preco Sr®Ft 7Oq 3& 397 � <br /> Aft,ch edelbnal hkI.N.—UK C6TakenaM wawwMcawaaor Date Signed C-57 License Number <br /> DNR IN REV.12000 WADMTq SPACE IS NEEDED-USE NEXTCONSECUTVELYNaMREREDFeRM <br /> , I <br /> I <br /> I <br /> } <br />