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fRIPI.ICATe <br /> s• <br /> owner's Copy /"r � rn•rF: 'Ir I:Ar.tt-I nwt.� w II -. ( <br /> tiyELL COMPLETION RE1,0111,71 _ <br /> PyF,e, Of krJc►lu InlrJlutu,n 1'Nnlphlrm STATE WELT NU,STAiIomNO <br /> Owner's Well 1Va. No. 488283 <br /> Date Work 13l'gan ` � l. lLAi11l/DE ❑ LONGITtIo£ ❑ <br /> Local 1(.rulit Agl•ncy e <br /> Permit Ntl. Sail J0044ulf, Dept. APNITRSQ1HFR <br /> 4 Lrmil IJah• <br /> 'OLOGIC LOC. W1:1.1. 4)IVNIsli <br /> ORIENTATION (4} VERTICAL _HORIZOmTAL —ANGLE —(SPECIFY) N:......Few G�o i e <br /> DEPTH FROM �C/A1 T— <br /> UEPfII TO 1•Yliyl' WATER 54 (Ft.) BELOW SURFAC)C Alai(ir1g rlJclrra� <br /> SURFACE DescR3rrloN <br /> FI. to Ft. DcstTibe»material,X►a ere,rolu►,rte,. CIi—i,ra CY— Cal ST zlP <br /> ' WEIR. LOCATION <br /> nlllll(ja� „�-&- _ no@ Rif. <br /> 17 ' 41 -avel <br /> AI'N ISlkrl..�� I'a);r•----.._.. I';ul•rl <br /> N <br /> '1'rntn�llill__—_ IlanHl•— - SI•r•liuu— <br /> I.:Hilnl�r hillgillidl. _ WEST <br /> r 1 ULU MIN SEG DEG + tall + SEC. <br /> r19 , <br /> 161DIAICA•IAON SI FTf 11 ACTIVITY (4) <br /> NUR[if --- - ----- NEW WELL <br /> r MOWFICATMiREPAM <br /> r <br /> 24 <br /> r <br /> _Depen <br /> 5 Clay <br /> Orhar(Speuty) <br /> r.IIESFROY(Dascnoa <br /> ' PraeeAees and Materials <br /> Under <br /> PLANNED LISE(S) <br /> MomlrolelNO <br /> WATER SUPPLY <br /> r r <br /> r 4 Domeel,c <br /> r <br /> _ P„hloe <br /> 6riaelmn <br /> 1 <br /> Indaalnel <br /> ' _ -TEST WELL” <br /> ' _-_- CATIKMIC PROFEC- <br /> ..._...... room <br /> Illunnarfr m I h,r r In Ih,ldnr r.,J 11 r 11 l......f,nulnr.t+1.. _ 07►ER(Specify) <br /> i III III 1 INT: <br /> r . METHOD __ �, FLtJID <br /> ` S1A'1'I•:1( L1:vI•:r s 1I1:L1) OF (:I)AlE'1,1{'1'li IVFL . <br /> ' IJFI'IH OF STAIIC <br /> WAILH LEVEL --_(FI.) d UATE MEASURED <br /> _ L;TIMATEO YIELU•..� - (GPM) 3 IESr TYPE <br /> '(OPAL DEI'FII OF BURING -- 945_(Frrt) IE5T ILNGTII-- (Elis) TOTAL DRAWDOWN (Ft.) <br /> TU•FAL DEI'TII OF COAil'xm) WFI.1. _(�nt) ILn nut be" r•�n'1rr.ur.ru <br /> ! I.I ..rll'r lour;n-n'+ vu•Gl <br /> DEPTH CASINC(S) <br /> BORE- ANNULAR MATERIAL <br /> FROM SURFACE �..— _.. —�._ UEI'7H <br /> HOLE TYPE FROM SUIIFAGF. TYPE <br /> DIA. z o •.+ MATEIA&L/ INTERNAL GAUGE. `.1111 SIZE "- - -- - <br /> (Inches) z� S CanAl DIAMETER OR WALL IF ANY "'-""" --' CL, III <br /> FI. to :Ft, id .N _ (Inches) THICKNESS tlnrmral I I tr, It MUNI 101,1111— FUL FILTER PACX <br /> 51ZE) <br /> 1 ) 1-1 <br /> 164L 14 -x 13 Ur <br /> r <br /> ATTACIIM1IIiN'rs ('} t.i.)1'IIFIC1f111N STA'I'I:A11:N'1' <br /> Geologic La/t I,Fl1s undersigned,certify that this Iepurt Is cumplelu and accurate* 10 the hest 01 my knowledge and beliel. <br /> Well Construction OreWem NAME( NPII`')1�l'II'Rlls-j'—Y-rr•� <br /> Geophysical LOW311 <br /> Sods Walef Chemical AnalysesAVEf y`'r <br /> A[[gA <br /> Other <br /> ATTACH ADDITIONAL INFORMATION. IF IT CxtsrS Sigisird <br /> WL LLR A 11 /fU PRk AN A l,' #.�Ifa-- C���dLN <br /> OW11 Ih11REV.7.1A1 IF ADDITIONAL SPACE IS NEEDED. USE NEXT CONSECUTIVELY NUMFIFFif U 1-011M <br />