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! U <br /> 'The free Adobe Reader may be used to view and complete this farm. However,software must be purchased to complete,save,and use a saved fom, <br /> File Original with DWR s Slate of California DWR Use -DO Not FBI In <br /> Well Completion Report <br /> Page�_, Of ' /A ReWwbLNrnMbn Pa pmu <br /> 4.mera Well Number M No. e0095493 - Stale Wen Numtlt�edsite Number <br /> Date Work Began 2 O ) Date Work Ended 2-3 2 La� LL_L_L o ,�r .. <br /> Local Permit Agency 6(I fE <br /> 51205 7777 Pefma Dale APNrtRSTghor <br /> Permit Number - <br /> Geolo is Log Well Owner <br /> Orientation Vertical OHodzonlal OAngle SpeWy Name_ 1,5 GO 61 t/ <br /> Drilling Method WWI;Fluid Mani dress ZL r TUaj&,L1'1Ae- <br /> Depth from Surface Description <br /> Feet I Feel - Desaihe maledal reM size color etc Ci r%A M A Stale <br /> Well Location <br /> w Address S 1 <br /> City "CVO C-A County su'l'ly 1 <br /> V,4 C-ArXIMPE Latitude ___ N Longitude <br /> Deo. I.an sec Dm. Aen ser_ <br /> L l dpe(,( Q Damm Dedmal Lat. 7+0 Dedmat Long.1Zl <br /> APN Book 23 3 Page 3 7 Parcel 3 d •f <br /> W i Township RanSe Section ' <br /> Location Sketch Activit <br /> -s 0slwun mNerm aMwe trma amen term is ONew Well j <br /> Nord' O ModificationfRepak <br /> .� O Deepen <br /> 17 11W TV $ OOther <br /> Destroy j <br /> ws�aorac low <br /> f-r Planned Uses <br /> O Water Supply <br /> ❑Domestic ❑Public <br /> 3 ` w ❑ingation ❑Industrial <br /> ( O Cathodic Proledion <br /> I� O Dewaledng <br /> O Heal Exchange <br /> r- O Injection <br /> Mw-7-49, O Monitoring <br /> } O Relation <br /> [0115f a ft S Ir W Test O Te <br /> south 0 Vapor Extraction <br /> eaeasdeulYse.+mtlwmM rmA errrr+tw, <br /> QOlher <br /> rN.0 e.esvx..ee r. <br /> y - Water Level and Yield of Completed Well <br /> Depth to first water (Feet below surface) <br /> Depth to Static <br /> Water Level 910 ' (Feet) Dale Measured 7f2-3109 <br /> Total Depth of Boring 7, Feet Esfimated Yield' IV JOIJ,_ (GPM) Test Type <br /> Total Depth of Completed Well M ItIf Feel Test Length (Hours)Total Drawdown_(Feel) <br /> 'May not be representative of a weirs long term yield. <br /> Casings Annular Material <br /> Depth Rom Borehole Wall Outside Screen Slot She Depth from <br /> Type- Material <br /> Surface D1r hes) Thtoknnches) (InDiatel) Type ItAny(inches <br /> Surface F111 Deacdptlan <br /> Feel ro Feel Mores (Inches) Inches IrxMa Foal b Feel <br /> I <br /> I <br /> Attachments Certification Statement <br /> ❑Geologic Log I,the and signed,lyi& that lhis(�port is co mto and accurate to the best of my knowledge and beflef <br /> ❑Well Construction Diagram Name n C Sf C.L� `+ <br /> ❑Geophysical Log(s) 2 3�f.n���(°1"�1t�pal waa�rtM he, S ]frM CA 9 5 ZO 5 <br /> ❑Other rChemMalAnalyses Sigrredl,',pi^/'e0yld.fr�l filtES/p,iec.is� 7/Zr/(d a& 3�n 3f 7 <br /> 13 Other <br /> NL-h aBddanNlnfomrv' aaerius asr lxaneewaw wd convx+o. Dale Signed C-57 License Number <br /> MR IN REV.12008 nFA IWSPACE is NEEDED,USE NE r CONSECUTNELY WMBERED FORM - , <br />