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U U <br /> 'The free Adobe Reader may be used to view and complete this foam However,soMrare most be purchased to comelole,save,and reuse a saved lam. <br /> File Original Wim DWR State of California OM the On -DO Not Fill In <br /> Well Completion Report <br /> Pape of I //'' Rr MMxal.WonParyMtlel <br /> Owners Well Number 1' �'10 No.e0095492 Stele wan Nombu/5ile Number fl <br /> I Dale Work Began Z q Date W rk En d 3 Lau1We Lo imde <br /> Local Permit Agency s a Ur C ✓ l <br /> 11 Permil Numbers 7 Permit Date 9 APN/rRSlOmer <br /> i <br /> Geologic Lon Well Owner <br /> OrientationVertical 0Horizontal OAnq specify Name fltmois CO �/ <br /> Drilling Method I W Drlirmg Flare Malnn Address 2 L off' <br /> Depth from Surface Description p <br /> Feel m Feel Describe materiel rensize'wbr etc Cil Slate LSL.YL .--Sr=i., <br /> Well Location <br /> Lo LU :;141 Address 4S RCity County SR1.�1.7T Latitude N Longitude <br /> Deo. Atte See. <br /> L os`c <br /> Datum DedmaLsLg7r7T0 Decimal Lg.iU F <br /> 1 <br /> AN 9nok 2 3 Z <br /> Page 37 Parcel 00.3/0 JL <br /> N 1 Tomishi Rama Section <br /> Location Sketch Activity <br /> e , sawn mala arewn aaromNrrmma New Wet <br /> we A4K4 haNorm O ModificalioNRepak <br /> O Deepen <br /> S ! OOlher <br /> Destroy <br /> o..eaapeunme.emwr. <br /> - .,,. wergnmcrm <br /> Planned Uses <br /> O Water Supply <br /> G. ❑Domestic ❑Public <br /> -� ❑Inigalion ❑Industrial <br /> O Cathodic Protection <br /> O Dewatering <br /> O Heal Exchange <br /> O Injection <br /> MVM-G O Mordtorirg <br /> _ O Remediation <br /> (I SfYtP�', O Sparging <br /> South O Test Well <br /> obmaenaoe exanmr.utaa.1e.e..awawvr O Vapor Extraction <br /> d.,.,ee.ra.s,a w.u»mua.ra»sa.®e.v. O 011ier <br /> N..»ae».rew <br /> - Water Level and Yield of Completed Well <br /> Depth to first water (Feet below surface) <br /> Depth to Static / <br /> Water Level (Feel) Date Measured 7 IZ3!U`I <br /> Total Depth of Bering �'�^1 Feel Estimated Yield• Alin- (GPM) Test Type <br /> Total Depth of Completed Well /V/� Feet Test Length (Hours)Trial Draysf w_(Feet) <br /> 'May not be representative of a mil's long term yield. <br /> Casings Annular Material <br /> Depth from Borehole Type Material wall Outside screen slot size Depth from <br /> m <br /> surface Olaetar Thickness Diameter Type if Any surface Fill Description <br /> Feel le Feel (Inches) Inches Inches (inches) Feal le Feet <br /> I <br /> Attachments - Certification Statement <br /> ❑Geologic Log - I,the andIXINed, ,Fft ly that this report IsF�nplate and accurate to me best of my knowledge and belief <br /> ❑Well Construction Diagram <br /> Name rpaeraP Gf 57 fM SnV1AriA!/ •1 <br /> ❑Geophysical Log(s) - 2 51h_y tenr'' n Yp"aL1.Gt->. I•y CktV!,I fig, 9 SLO S <br /> ❑ erChemicalAnalyses <br /> ❑Other Signed m !' �fi' '(U .-2oisir�h7(z`�/d9 UiL, 3H? <br /> Omer <br /> atxnaedama hrmreuae rnenu. urLimneeewNerwar GO^"mOf DetOS wed C-67 License Number <br /> VNR <br /> IN REV.IR006 FMpmO WP IS MEMO.USE NO(r CCNSECUrrALY NUMBERED FORM <br />