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• I <br /> � I' <br /> r V <br /> 'Tho free Adobe Reader may be used to New and conplele this roan. Fbvever,software nasi be purchased to complete,save,and reuse a sated(orm. <br /> He Original with DWR - Stale of California DWR Use Only-Do Not Fal In l <br /> Well Completion Report <br /> Page�_ of I ROvrb audrwrPwrprkr State Well Numberrite Number <br /> Owners Well Number W—3 No. 0095489 <br /> Date Work BE Z 2!/O Dale W Ende 2-3 20dLatitudeLatitude Lo 7We <br /> Local Permit Agency 5 C Uc <br /> Pomlil Numbor_ /t 7 '� - Permit Dale LO 9 APWfRs/gher <br /> Geologic Log Well Owner <br /> OrientationVertical O Horizontal OAngle SPecaY Name cm teOl l <br /> Dn91ng MCNoa n aril 5 Drilling Fb d Ly� Mail Address 7-7-10 Z kd wm ri� <br /> Depth from Surface Description <br /> Feel m Feet Describe material b size,color,etc CII Stale i RS <br /> Well Location <br /> • Address ( <br /> city _rryl.G! C4}' County Sla•k A (/( <br /> 1/(x'1 Latitude NLongitude__�N <br /> Deo W. Sec. <br /> t Datum DecimalLal.37.71ig DedwmfLoi.(ZIss•.4 <br /> (7 <br /> APN Book 2.33 Page 37 Parcel <br /> e Township —Ran a Section <br /> Location Sketch Activity <br /> Q d ssahtlhmNll»drarm hang alMbm6 ()New Well <br /> North O MociificationBtepalr <br /> O Deepen <br /> S O Other <br /> . Destroy j <br /> oeaa.hr�ea.r eye mru. <br /> Planned Uses <br /> O Water Supply <br /> .. 4Cel ❑Domestic ❑Public <br /> 0 <br /> 3 3 � w ❑Irrigation ❑Industrial <br /> �+ O Cathodic Pmlection <br /> lL- O Dewatering <br /> I" W3 Q Heat Exchange <br /> 0 Injection <br /> O Monitoring <br /> O Remediation <br /> O Spargkg <br /> .. O Test Well <br /> South w.r.ueNeae a.rweSouth .er,eazoa rem+. O Vapor Extraction j <br /> a.«w.E.ed.e.ui..+w.emeirwwr..ww. O Other <br /> YM..M usaan xM <br /> Water Level and Yield of Completed Well <br /> Depth to first water _ (Feel below surface) <br /> Depth to Stell <br /> li Water Level 0/1 Z (Feet) Dale Measured 7(Z3/0 <br /> Total Depth of Boring /VIA <br /> Feel Estimated Yield' (GPM) Tosi Typo <br /> Total Depth of Completed Well. /tv _ FeetTest LergN (Hours)Total Dmvdavn_(Feeq - <br /> 'Ma not be represenlative of a well's lonn term yield. <br /> Casings Annular Material <br /> Depth from Borehole l' Wall Outside Scroan Slot Size Depth from <br /> Surface Diameter typo Material Thickness Diameter Typo If Any Surface Fill Description <br /> Feel w Feel finches),, pncites Inches inches Feet w Feet <br /> Attachments Certification Statement <br /> ❑Geologic Log I,the urtdo ,1,ned Srply Mal l r�ggnplate and accurate to the best of my knowledge and belief <br /> ❑Well Cons taction Diagram Name ,.aNN IcC�Irnr.wn ,!." A. Q �^ <br /> ❑Geophysical Log(s) 23 Ob re'F� aUGCaK (�✓1 r f7GF—� CA /5 ZO! <br /> ❑other ter cnemial Analyses Sjgne&/1.A TEj1WES//1�5ia1 DIl -.41011 03638 / <br /> ❑Other �t•41M <br /> Alwd, 1,amahaaadaa I �rt�dw+'ww^'�mr Date Si ned C-57 License Number <br /> OMR 185 REV.140041 - K ADOR1DfUl SPACE M MEMO.USE mWr WNSECU`r E Y 1AMCHEREDFOW <br />