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QUADRUPLICATE STATE. OF CALIFORNIAA e Y — I FI IN — <br /> For Local Requirements WELL COMPLETION REPORT <br /> Page I _OI I Refer to Instruction Pamphlet STATE WELL NOd STATION NO. r <br /> Owner's Well No. No. 495132 11 <br /> L <br /> Date Work Began Ended 5-5-93 LarnlroE LONGIFUDE <br /> Local Permit Agency I I I I I I I I I I <br /> ililli Permit No. 9j OW4 Permit Date V-5_9" <br /> GEOLOGIC LOC WELL OWNER <br /> ORIENTATION _X VERTICAL _HORIZONTAL _ ANGLE _ (SPECIFY) Name Mike `"Ak-k49di r*h <br /> DE17H TO <br /> DEPTH FROM FIRST WATER (FL) BELOW SURFACE Mailing Addres, 3404 S 114Qh MV 99 <br /> ^i <br /> SURFACE DESCRIPTION cm Stoc�t op OM1• "?STATE ZIP <br /> FL to Ft. Desmbe material,Realm size,color,etc. WELL LOCATION <br /> 0 14 May Address 6411. Aghley TAnia <br /> 34 42 Sand and �_Ww�vei City stocktm, nk <br /> 42 72 Clay County - in <br /> i <br /> YFAI PN Book Page Parcel <br /> clay f3q Township Range Section <br /> -104 106 Sand Latitude NORTH Longitude I WES <br /> 106 132 DEG. I MIN. SEC. DEG. MIN. SEC. <br /> LOCATION SKETCH ACTIVITY (✓)• <br /> J32 IM sawNORTH -ICL NEW WELL <br /> 126 186 Clay MODIFICATIONIREPAIR <br /> IS6 188 Sand —Deepen <br /> 1M J" clay _other(Specify) <br /> 199 201 Sand <br /> 201 203 CJd3y DESTROY(Oeacaea <br /> 203 206 <br /> Prauaww aoa Mxxia <br /> 20fi 2955 Clay <br /> Wax^GEa.ocicloG <br /> N N PLANNED USES; <br /> 255 W ou ( <br /> 3 MONITORING <br /> clay WATER SUPPLY <br /> 6_ Domeatia <br /> P.1ohe <br /> Impetipn <br /> A11r I'q ImtuamW <br /> iI. ..TEST WELL" <br /> _ OAIHODIC PROTEI <br /> MR( 14 11993 SOUTH TION <br /> Illustrate or Describe Coroner of Well from Landmarks GTEIER(£pacify) <br /> r- VIROWA .. LTH such ae Roads,Buildings,Fenews,Ricers,etc. <br /> iM PLEASE BE ACCURATE & COMPLETE. <br /> DRILLING <br /> METHOD Had IYtiTY FLUID 1111r <br /> i WATER LEVEL B YIELD OF COMPLETED WEJL <br /> DEPTH OF STATIC <br /> WATER LEVEL OF <br /> A DATE MEASURED 5-7-9 <br /> ESTIMATED YIELD' (GPM) It TEST TYPE <br /> TOTAL DEPTH OF BORING 279 (Flet) TEST LENGTH— "a.) TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL 270 I F'rct) •May not be represenua6ty of a Ttx11's long-terns yield. <br /> DEPTH CASINGIS) DEPTH ANNULAR MATERIAL <br /> FROM BURFA(.'E BORE- TYPE FROM SURFACE TYPE <br /> HOLE — INTERNAL GAUGE SLOT SIZE <br /> DIA. W iF s MATERIAL/ DIAMETER OR WALL IF ANY CE- BEN <br /> GRADE FILTER PACK <br /> (Inches) <br /> Ft. to FL .� _ Oncnes) THICKNESS OncneMENT TONITE FILL sl Ft. to FL (� ) (� ) (�) (TVPEISQE) <br /> 25 <br /> 6« <br /> 0 , w « « a W2 liand ON im 220- <br /> .ATTACHMENTS (G) CF.R TIFICATION STATEMENT <br /> I,the undersigned,certify that this report is complete and accurate to the beat of my knowledge and belief. <br /> — Geologic lap ,a'],�� <br /> _ Well Construction Diagram NAME (:&'V 4t= DCU" '" 00-0 'Me <br /> (PERSON, FIRM. OR CORPORATION) (TYPED DR PRINTED) <br /> _ Sammy eicel Log(,) 304 S. Kil=Y Twiockv Ch. 943W <br /> _ SoillWaler Chemical Analyses <br /> ADDRESS CITY STATE ZIP <br /> Other <br /> ATTACH ADDITIONAL INFORMATION. 1F R EXISTS. Sign aQ' E - -- <br /> CLE RIZED flESENTAT1VE DATE SIGNED G51 LICENSE NUMBER <br /> DW'R IRR REV 7-90 IF ADDITIONAL SPACE IS NEEDED. USE NEXT CONSECUTIVELY NUMRFRFD FORM <br />