Laserfiche WebLink
s <br /> 'The free Adobe Roador may be used to New and complele this form. However,sollxare must be pordmased to compete,save,and reuse a saved form. <br /> File Original with DWR Slate of California DWR Use Orly-Do Not Fill In <br /> Page_ I of r Well Completion Report <br /> na�1O rnv1nidpn�"a'rOI Slate Well Numhedfide Number I <br /> Owners Well Number �'V- No. 00954 0 ® r <br /> r- —r-�I <br /> Date Work Degan L 2G0`� Dale Wo Ended Z 2009 Latitude LorQdude <br /> Local Permit Agency u `Yl �(AV <br /> Permit Number SROS'77-n Permit Date f nq APN/fRS/Wher <br /> Geologic Log Well-Owner i <br /> Oaenlallo /p¢meal f OHo'zon[at OAngle specify Name_ N S ?✓ <br /> Ddnn9 Method o ld H/STPAtis Drinlrg Fluid A)2= Maili Addmss ZZS6Z . / tA011 msil e- <br /> Depth from Surface Description CPr 7 53� <br /> Feet. -m ,-Feel. z Describe material Vin size cobr etc Cil IA/ r Stale <br /> Wel(Location I <br /> Lct-\ Address 17 IS 1 <br /> City fk-v%-C-!g, C4 (`o my SpVFs dtagllT <br /> wta C4 sm Latitude ___ N L"I'lude <br /> IV <br /> Dee. Aon Sec Deo. Min Sec <br /> C t 1 Ain, h6p KrAdt Q Datum Dedmal Lat.37.VO Decimal Long.X21.4( <br /> APN Book Z� Page 737 Parcel Gb 3/oy- <br /> lN 1 C %r4),AqTownship Range Section <br /> Location Sketch Activity <br /> stela mwee eraen hard allwlormb mea. Now Well <br /> N01ti' O ModificetionfRepair <br /> M W-� O Deepen <br /> S I,w _ � O other <br /> l�Desboy i <br /> ? oea.e.Remo.0 YY.eaaa. <br /> E6leax'L00' <br /> Planned Uses <br /> O Water Supply <br /> ❑Domestb ❑Public <br /> 3 ❑inigation []Industrial <br /> - O Cathodic Protection <br /> O Dewatering <br /> O Heal Exchange <br /> 0 0Injection <br /> O Monitoring <br /> O Remediation <br /> r I I IrK O Sparging <br /> South O Test Well <br /> ew.eor.,n,n,m.ma.aAae,veer.e,ar„e.,rare,, O Vapor Extraction <br /> .. nee.maY.a.n.,,iy.u.e.dea„r re.a,ee.mr. OOther <br /> YYur M•sarW atl Ya i <br /> Water Level and Yield of Completed Well <br /> Depth to that water (Feel below surface) <br /> Depth to Static TTT�.AA�' r��[((,,, <br /> Water Laval (Feet) Dale Measured9 <br /> Total Depth of Boring Z Feel Estimated Yield' N (GPM) Test Type <br /> Total Depth of Completed Well Feet Test Length (Hours)Total Drawdown (Feet) <br /> 'May nod be representative of a well's long term yield. <br /> Casings Annular Material <br /> Depth from Borehole �,� Material Wall Outside Screen Slol She Depth from <br /> Surface Diameter Thickness Diameter Type If Any Surface FIII Description <br /> Fed m Feel Inches Males I nchesl and.1Feet to Fed <br /> Attachments Certification Statement <br /> ❑Geologic Log I,the and igned,7M CM that tItnaport IS c r late and accurate to the best of my knowledge and belief <br /> ❑Well Construction Diagram Nam <br /> e-L= w5w1��ooJ OLNA p f/rl a]^ <br /> ❑Geophysical Log(s) : Z3foSi`rn WO A°�iA S Lfnln R 52ds <br /> ❑SoIbWOther er Chemical Anayses Signed OI'n a^a �/&.r S-,a, 71?-71? ?,,*36391 <br /> city Su <br /> ❑Other LVAM" <br /> algia l an axe>mn G6rlloaaea waren res ca,esuor Dale Signed G-57 License Number <br /> MR 165 REV.1/1006 IF ADDrIOPM SPADE IS NEEDED,USE NEXT DONSEDVRVELYm.UmERED FORM <br />