Laserfiche WebLink
ORIGINAL_ STATE OF CALIFORNIA DVFI U§E ONLX — DO NP.T..FILL 10 <br /> �— <br /> File with bWR } WELL COMPLETION REPORTLQJzIN10l6F_j1 9.9< <br /> Page—I— Of vv1 w �� �`� $4L to Inrtructron Pamphlet STATE WELL NO tSTATION NO <br /> Owner's Well No 3 - 3 ���" f N° 4 5 6 7 5 �A_g <br /> �Date Work Began Ended30 LAmtroe LONGITUDE <br /> Local Permit A enc r <br /> Permit N,, Permit Date Af3N/TRSiOTHER <br /> SOLO IC LOC WELL OWNER <br /> ORIENTATION (—' ) VERTICAL _ HORIZONTAL — ANGLE __ (SPECIFY) Name <br /> DEPTH FROM DEPTH TO FIRST WATER (FI) BELOW SURFACE Mailing Address /,'{ J <br /> SURFACE DESCRIPTION . ^r S SCJ i� <br /> Ft to Ft Dacrrbe maternal,gravis size color,etc CIWELL LOCATIONr1 01 <br /> Address <br /> A/ <br /> CAN a <br /> Count} <br /> b APNQT�Baok Page <br /> To�wnn%s ip lSG Range Section Id <br /> zod 9zI t 1 1 La tt,tude_ NOR T►s Longitude It WEST <br /> I r I DEG MIN SEC DEG RAIN SEC <br /> LOCATION SKETCH Af-TIVITY (.:L) <br /> NORTH NEW WELL <br /> i MODIFICATION/AEPAIR <br /> �rle Deepen <br /> —Other(Specify) <br /> DESTROY(Describe <br /> iProcedures endhistenels <br /> Und6r GEOLOGICLOG) <br /> ' r PLANNED USE(S) <br /> W <br /> e' Lu /f • ) <br /> 3 W <br /> �/ <br /> MONITORING <br /> WATER SUPPLY <br /> — Domestic <br /> Public <br /> r <br /> r _ irrigation .. <br /> '._ Industrial <br /> A TEST WELL <br /> CATHODIC PROTEC <br /> TION <br /> 111uatrate or Describe DistaQnce of Well from Landmarks — OTHER(Specify) <br /> such as Roads Buildings Fences Rtoers etc <br /> PLEASE BE ACCURATE it COMPLETE. <br /> DRILLING ` <br /> METHOD 1'-)-6-H �LILM -FLUID <br /> ' <br /> WATER LEVEL h YIELD 4)F WELL <br /> DEPTH OF STATIC <br /> WATER LEVEL (FI) d DATE MEASURED <br /> ESTIMATED YIELD' -----ZGPM) & TEST TYPE r1 <br /> TOTAL DEPTH OF BORING (Feet) TEST LENGTH rs) TOTAL DRAWDOWN <br /> TOTAL DEPTH OF COMPLETED WELL {Feet) *May not be representatrve of a well's long-term yield <br /> DEPTH BORE CASING(S) DEPTH <br /> MATERIAL <br /> FROM SURFACE HOLE TYPE :!L FROM SURFACE TYPE <br /> DIA Y W d MATERIAL/ INTERNAL GAUGE SLOT SIZE CE BEN <br /> (Inches) t x a GRADE DIAMETER OR WALL IF ANY FILTER PACK <br /> Ft to Ft W onches) THICKNESS (Inches) Ft to Ft MENT TONITE FILL <br /> (�) {�) (�) (TYPE/SIZE) <br /> , <br /> ATTACHMENTS CERTIFICATION STATEMENT <br /> f GB6b0'c Log I the undersigned certify that this report Is completeand accurate to the best of my knowledge and belief <br /> ltlzWell Construction Diagram NAMF <br /> .._ Geophysical Log(a) (PERSON FIRM OR CO ) (TYPED OR PRINTED) ^+"T <br /> SPR/Water Chemical Anaysea t 1 Q <br /> lam/ ASE Cfilt /zq&SATE 21P <br /> her (�(A,f f� y <br /> ATTACH OVAL T70 1!`1T EXIJTS fined a� <br /> tNELI D REPRESENTATIVE SI(7tED C57 LICENSE U BER <br /> DWR 188 REV 7-90 IF ADDITIONAL SPACE IS&EDED USE NEXT CONSECUTIVELY NUMBERED FORM (C <br />