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ORIGINAL ',TNT[ OF ( 11 II011\1\ DWR USE ONLY DO NOT FILL IN <br /> File with DWR rl WELL COMPLETION REPORT <br /> Pat -_L Or 1 Hr�r r 1" lu,lrrfr li'm Pumpli(r f STATE WELL NO/STATION NO <br /> ,oWtlf-, s sell ,. �1 vv— NO 731139 El ❑ <br /> 1)1 \"i(]I k Rl eir 111 ~ l.N[I[tl �l7 LATITUDE LONGITUDE <br /> • I (1t I� Pl /1111( ,�(ITL\ .--. APNITRSIOTHER <br /> P(I I If No a - Pc t Nrlt D ttc �_f I � I -O <br /> GEOLOC IC LOC; WEI I OWNER <br /> DRFENTATIDN (4] /VERTICAL —HORIZONTAL —ANGLE —(SPECIFY) N 1111( t+ <br /> DRILLING ':t <br /> DEPTH FROM METHOD FLUID M T�IylTn>.~,Ac!(lrc tis _ _ <br /> SURFACE DESCRIPTION K ti�,� \al to <br /> I to FI Df v hilt mate,I lol til(Iln Slz( ((dol (1( CITY STATE ZIP <br /> L'll LOC,gll <br /> Cl __... _.�.�r—� <br /> APN Book Lia- Pagc 'i P ttccl i I <br /> t; \!�1 T[xvminh R,lns;c 5l <br /> Latltndt. i I NORTH LrtndL I L_ wEsr <br /> fa�1 DEG MIN SEC DEG MIN SEC <br /> t ! LOCATION SKETC11 A(TIN IT] I — <br /> NORTH ✓NEW WELL <br /> y MODiFICATION7REPAIR <br /> Deepen <br /> Other(Specdy) <br /> .y Y DESTROY(Describe <br /> Procedures and M9fO <br /> Under LOG GEOLOGIC LOG <br /> PLANNED USES (.�L) <br /> WATER SUPPLY <br /> DomesL¢ Public <br /> rIrrigation eduglnal <br /> C5 ~ <br /> f W MONITORING N- <br /> `] TEST WELL <br /> I,l CATHODIC PROTECTION <br /> HEAT EXCHANGE <br /> DIRECT PUSH <br /> i <br /> INJECTION <br /> VAPOR EXTRACTION <br /> i lI SPAgGING <br /> SOUTH REMEDIATION <br /> I7!(Isl,ute .0 1iOlsfelwe rf U,Il finnr Runel, B,nfdui-, <br /> i Fcrncn Heac rt Itc curl afffu 11 rr nirip sc rrf&lrtunrnlu,lni r( OTHER(SPECIFY) <br /> nccc wto if PLEASE RE ACCURATE d:CO,tIPI ETF <br /> WATER LEVL & HELD Oh CONIPLLTED NLLL <br /> I f <br /> i DEPTH TO FIRST WATER {F1) BELOW SURFACE <br /> i DEPTH OF STATIC <br /> WATER LEVEL (F[}&DATE MEASURED <br /> ESTIMATED YIELD (GPM) & TEST TYPE <br /> 10 1 Il DH 11111 Ot 110111\4 —I E[t U TEST LENGTH (Hrs} TOTAL DRAWDOWN IFt} <br /> 1O1 Il DI 19 11 Ol (O\ PIFT1 I) \ll I I ?2L III,tl 11rr]' lrvi Gc represurttttr r of a el(, long-IeIm I'll If/ <br /> DEPTH BORE <br /> I (S) DEPTH III t1l NIAlLR1III FROM SURFACE HOLE TYPE (.�L) FROM SURFACE TYPE <br /> DIA r z == a MATERIAL! INTERNAL GAUGE SLOT SIZE CE BEN <br /> (Inches) a ozQ a GRApE DIAMETER OR WALL IF ANY MENT TONITE FILL FILTER PACK <br /> F1 to Ft m m v o I4nchesl THICKNESS (Inches) FI to Ft (TYPElSkZEI <br /> ,1 FTA( i1MI \1 S (Lill 11 1(ATIO\ S FATI \IL\T <br /> I the undersigned certify that this report Is complete and accurate to the best at my knowledge and belief <br /> Geologic Log , S 1 <br /> VVI Construction Diagram NAME W ✓� <br /> �tPEERSO FIRM OR CORPORATIONI (TYPED R PRINIl,l ' <br /> _ Geophysical I <br /> SollfWaler Chemical Analyses <br /> Other ApORESS ( tt CITY ` STAH-yfr ZIP <br /> ATTACH ADDITIONAL INFORMATION IF IT E"XIS TS S'Sned <br /> WCL O LE /AUTHORIZED REPRESENTATIVE GATE SlfN 0 l yl LICi NOV R <br /> rns t n I I t I IF ADDITIONAL SPACE IS NEEDED USE NEXT CONSECUTIVELY NUMBERED FORM <br />