Laserfiche WebLink
u <br /> 'The free Adobe Reader may be used to view and complde this form. However,sollware must be purchased to comple(e.Save,and reuse a saved form. <br /> File Original with DWR Slate of California (NOR use Orgy-Do Not Fa In <br /> Page of Well Completion Report <br /> M W-V a wkMrin Pao pwer Stale Well Numbe MW Number <br /> Owner's Well Number No. 095494 <br /> Date Work Began S �- zea Dale Work Ended 23 20 9 Latitude Lon - da <br /> Local Permit Ag (A r EtA✓. <br /> Permit Number lK Orj]7]� leem it Dale O&tv1 sf' 2!109 AFWmSrDlher <br /> Geologic Lo Well Owner <br /> Orientation Vertii ally 0Horizontal OAngle Specay Name P/ Ili l pp,, �)01'F <br /> DAkhg Mdhnd J((XVs OrYling Fluid Mall ng Add res� 2Zy� Z N. T&uI UM'L('te <br /> Depth from Su Delon '�IrtlA rwl —04--710 9 S3 <br /> .Feel b Feel et Describe malenal,aminrain size odor etc Cil Stale <br /> Well Location <br /> (-S Address <br /> CiIY I Count' Si!LA UL IrLIk <br /> UV rl't C "S Latitude N Longilude— _yv <br /> Uea. sin. Sec Dao. AOh. Sec <br /> oIGL C' Datum Decimal Lal.-3 7 Decimal Lon (ZI 'it7 <br /> OA&eA 10APN Book L 7�7 Page 37 Parcel <br /> C yam( Townshi Ran Section <br /> Location Sketch Activit <br /> ssekhasMMMaen Mrd silo bnn is <br /> ONWell <br /> NoM <br /> O Modification/Repair <br /> O Deepen <br /> AEF H g Yrfipee O Other <br /> )astray <br /> o.,aa��.ewa..enw <br /> . - w.eEmorctar <br /> Planned Uses <br /> O Water Supply <br /> 3 ❑Domestic ❑Public <br /> 3 ❑Irrigation [Industrial <br /> O Cathodic Protection <br /> O Dewatering <br /> O Heat Exchange <br /> O Injection <br /> O Monitoring <br /> O Remediation <br /> CCA Sf 5'�'a"cM1� O Spar9atg <br /> South O Test Well <br /> . o.u�aama.ea.unynus�abr.wxau.r.r,. OVapor Extraction <br /> nruaacwutaas o.ur.ermarawrrew.ssw. OOther <br />� rtw.sr«a.wmaw. <br /> Water Level and Yield of Completed Well I <br /> Depth to first water (Feet below surface) <br /> Depth to Static <br /> Water Level • 14 (Feet) Date MeaSuredJ 2S <br /> Total Depth of Boring T - Feet Estimated Yield' IVIff (GPM) Test Type <br /> Trial Depth of Canpleled Well <br /> N 1 Feet Test Length (Hours)Total Drawdown (Feel) <br /> I'Man,not be representative of a well's term yield. <br /> Casings Annular Material <br /> Depth from Borehole Wall outside Sereen Sot Size Depth from <br /> Surface Diameter Type Material Thickness Diameter Typo If Any Surface Fill Description <br /> Fad b Feet Oncheal Michael Inches ndms Feel to Feet <br /> L <br /> Attachments Certification Statement <br /> ❑Geologic Log I,the ande1signeq cpnlfY that Ihi repot ISgnete and acarrate to the best of my knowledge and belief <br /> ❑Well Constructlon Diagram Name '"Fr r7LC Sr�crgGpnLel LNrLU/MF � / i <br /> ❑Geophysical Log(s) 2-771 4 F�pWN rk 151"1" SF/UGty%'% CA '75-20-] . <br /> ❑SdVWalerChemical Analyses /� /� rely sub Zi <br /> ❑Ogler Signac! a Ar-Wr5 Atecxoc, I2cl D __ (,36391 <br /> Anxh eaaaaut aa.aw. asr(rceneswwvwwcomaam Dale Skined C-57 License Number <br /> MR IN ON.I/tODG IF ADDITIONAL SPAC[r3 xFFo[O,USEHIXi CONSECUI1wR.V NIIMBFa£o FOAM <br /> i <br /> i <br />