Laserfiche WebLink
t QUADRUPLICATE j r <br /> For Lli iRe wrements 4 STATE o); CA1JFOITNIA 4 4 <br /> r^� DWR USE ONLY — DO NOT FILL IN <br /> kif <br /> [�r } ALL COMPLETION REIPOR�,. <br /> Page Of tot —I +,ii NKW—S Refer to I,I.,rr-rlcrio�r )olr1r•r I 1 <br /> STATE WELL NO./STATION NO <br /> Owner's Well No. -1 I 1 011 -S,4 // No. 7465201 <br /> /� O I ❑ ❑ <br /> Date 1[7ork Began D` , Ended z�l00 *f LATITU QE <br /> LONGITUDE <br /> ( Local Permit Agency 5414 GDccl., .wv�r�a�reN� Gia I t1/rfr` <br /> �J Permit No, d Q 2 Permit Date 3 aPwrRsrorHER <br /> GEOLOGIC LOG I <br /> ,r ORIENTATION '`Iy'llLL O��'NE{i <br /> {�) VERTICAL —HORIZONTAL ANGLE i(SPECIFY) Natllel�I e1 "l�Il V�'[U �� t <br /> DRILLING / lr i <br /> METHOD FI' W F°. • ! 1F} ,r <br /> DEPTH FROM FLUID N''t�13,11g l3'eS8 -- - / 7/ <br /> SURFACE DESCRIPTION [ f`4G C <br /> Ft. to FL �r'S'C 1'71JC 7,tatcrial, 7-(1711 .5'1;,d', color, Cdr. CITY ty STATE r <br /> F ZIP <br /> v L LocAT oe6 <br /> Address <br /> � I City <br /> 5 <br /> Crnulh, <br /> i APN Book I'�i�e <br /> I , Parcel <br /> Tort=nsllip Bangle Section <br /> Latitude III i I NORTH Longitude— I i WEST <br /> DEG. MIN." SEC DEG. MIN. SEC. � <br /> 1 I I LOCAT BOOR H KETCI3 ACT117ITY { ) <br /> I I f NEW WELL <br /> I i I MODIF[CAT I ON/RE PAIR <br /> C' — Deepen.. <br /> Other(Specify) <br /> l ! <br /> I I I � DESTROY(6escribe <br /> tII Procedures and Materials <br /> I I - S �O.y�p „••,p/f��.Cp A a(��'4 Under"GEOLOGIC I.OG'J <br /> VC� r '•�7 rll� ! PLANNED USES I--) <br /> I I <br /> ry� 'j WATER SUPPLY <br /> Q 'Y Domestic _ PubIrc i <br /> N <br /> !i Irrigation _ Industrial <br /> I I "� !� - C i� w MONITORING <br /> J TEST WELL <br /> I I <br /> CATHODIC PROTECTION <br /> • 1/G J;n 'Q r,(/ HEAT EXCHANGE <br /> I _ DIRECT PUSH ' <br /> I r ! K •O�,s D'� Oi,G_ INJECTION <br /> VAPOR EXTRACTION, <br /> � I <br /> SPARGING <br /> SOUTH REMEDIATION <br /> 71PItslrnlc or Descrilx Uisleincc of'Vell,({.'rom Rnads,Ru[1rlili , <br /> I I Faces,RiocrF.Glc arld allach a soap. Use adriilionril ppla1Jpr fj OTHER(SPECIFY)_. <br /> e/�r ner-evv-l.Pffi ff BE ACCURATE&CObIPLt'TE. <br /> WATER LPti'E ,jiIc YIELD OF COMPLETED WELL <br /> I , <br /> I I DEPTH TO EIRIST WATER} (Ft.) BELOW SURFACE <br /> I I DEPTH OF STATIC 11 <br /> WATER LEVEL (Ft.)&DATE MEASURED <br /> ESTIMATED YIELD ' �i (GPM) & TEST TYPE <br /> TOTAL DEPTH OF PORING (Feet) I — <br /> TEST LENGTH I�(Hrs.) TOTAL DRAWDOWN (FL) <br /> TOTAL IJEPTl1 OF COMPLETED WELL (Feet) *May'izot Gc r-epreseutative of a well's long-term yield. <br /> DEPTH <br /> CASING S DEPTH ANNULAR MATERIAL <br /> FROM SUFACE HORS TYPE( �} ( l �F FROM SURFACE <br /> TYPE T <br /> DIA, r w o a MATERIAL! INTERNAL GAUGE SLOT SIZE <br /> GE- BEN- <br /> (Inches) g w¢ �� a GRADE DIAMETER OR WALL IF ANY l MENT TONITE FILL FILTER PACK <br /> Ft. to Ft, v v (Inches) THICKNESS (Inches)I Ft. to FL (TYPEISIZE) <br /> ATTACHMENTS CERTIF:ICATION STATEMENT } <br /> I,the undersigned, certify that this report is complete and accurate to the best of my knowledge and belief. <br /> Geologic Log 1 <br /> e Earr <br /> _ Well Construction Diagram NAME <br /> IPERSCN, FIRM. OR CORPORATION) {TYPED OR PRINTEDI <br /> Geophysical Log(s) -� <br /> ;J <br /> W <br /> _ ScAl AAa�tte�rr Chemical Analyse A �' <br /> Other.'��` W'7i1 f < ADDRESS 1.�:� "'* If CITY 1 STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION, IF IT EXISTS. Signed _ <br /> WELL DRILLERIAUTHORIZED REPRESENTATIVE tI ;� DATE SIGNED C-57 LICENSE NUMBER 1 <br /> LAVA MS RF,v, 11-97. IF ADDITIONAL SPACE IS NEEDED/, USE NEXT CONSECUTIVELY NUMBERED FORM ,[ <br />