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0 0 <br /> *The free Adobe Reader may be used to view and complete this form. However,soAv2re must be purchased to complete save and muga a SatRd fob <br /> ' File Original with DWR <br /> State of California DWR Use <br /> Page + of f Well Completion Report -°O"°`F0 <br /> Owner's Well Number earerro rrutrvaron Parrmnrer <br /> Data Work' Began - umber/Sita Number Date Work Ended <br /> Local PermRAgency San Joaaui Co my rcaM nial Fr Ladtude L— Ibda <br /> Permit Number904B t rte t <br /> __.�,__- �_ Fermi[Date X37/Dfi oth r <br /> Orientation O Vergcal O Horizontal _ – -- A - - vrl n_ <br /> Drilling Method OMgle SpeGfy Name Bo lr Estate CIWMB <br /> D£pdt froRr SUHac£ DrIII g Fluid <br /> Fsak IoOasgripflon Mailing Address 1001 1 Street <br /> Feel ... DeWrte moraria^I,gr�ndie.cabir.CtO � I City stcramill <br /> ' <br /> State CA 71p 95812 <br /> A t��ULDsatloi+ �'�` <br /> Address 28425 S.MacArthur <br /> City Trial <br /> t R.„'_ County San Jo urn <br /> ' Latitude 37 Dm. Nsa sae N Longitude t21 2b _26 w <br /> I• fi .r7-+ 6J"ftiS Datum i��m W+' see. <br /> f=A.CrrYYi�; -- Decimal Lat� pBGrrtal Long. <br /> APN Book Pape Parcel ... <br /> r+�w 'G�LL1W 7 <br /> wilivill Township 33 R:rr•.5F S�t1on 9 <br /> -�- Location Sketch- <br /> Activit <br /> .�. {� ' T7 ! miG,:Im vavr rvhn7a4'ortam isLt�;t7 <br /> "beth ONew Well <br /> ' <br /> 1 r O MOdiAcafion/Repair <br /> WAS till nI'd L1rl 1i 0Deepen <br /> OOther <br /> .< t.1+`t7ii`35, � �°°•oe°«"i°oac”tett�°'"'� <br /> A Planned Uses <br /> a O water Supply <br /> 1 E ^tL !V S ❑Domestic ❑Public <br /> ❑IMgation ❑Industrial <br /> ' O Cathodic Protection <br /> O Dewatering <br /> O Heat Exchange <br /> M <br /> Olnjection <br /> ' 4r ,. . !(✓ _:. ) O Monitoring <br /> O Remediation <br /> 'Jill 11 <br /> O Spa ging <br /> - -�� south OTes[Well <br /> ' IrNmamo aecne.mrorwsar..earom meea,�aros N,p, angling <br /> South <br /> Extraction <br /> ("(.' a'�A7>» f iS // a`.R.ae. amucezmaP.uarsewpnc wceramr.0-air. OOther <br /> (tT PNw 6. .unb.MooiwM. <br /> �• 03f� 7t? LNater Leval and Yield of Com feted Weilh to first water " <br /> Depth to Static (Feet below surface) <br /> Total Depth of gpHng 122.5Water Level (Feet) Date Measured <br /> Feet Estimated Yleltl• (GPM) Test Type_ <br /> Total Depth of Completed Well 122 Feet Test Length (Hours) Total Drawdown <br /> "May not be representative of a weA's Ion t Held (Fent) <br /> ' Gasfn An g termlarateriai <br /> Depth from -',Bprofrole T Wall Outside Screen Slot Size Depth from r <br /> Surface 1YInche B[ IIPe Material Thidinal Dimmeter T e ItAnY Surface Fill p <br /> Feet to Feet Inches YP eeeriplion <br /> Inches Irldtes <br /> 0 102 a' Blank Inches Feet m Feet 702 123 a s«ean PVC Sch.40 0 2 Cement <br /> PVC Sch.40 seal <br /> o.o7p z 9a Carrent <br /> 84 99 Bemonhe <br /> B9 123 Fitter Pack M2/12 sand' I <br /> Attachments <br /> ❑Geologic Log I the undersl ned Cerfift11 1 Staterml <br /> 9 certify that this report Is complete and accurate to the best of my knowle a and belief <br /> ❑Well Construction Diagram Name ca+eeao prom ma, NS IALt-sr� dg <br /> ❑Geophysical Logs) Peraon.lill awalmn <br /> ❑Soil/Water chemical Analyses CA <br /> ❑Other Signed Addasa Cry Stare zm <br /> chaoellia+ai lid eon I e�asta. cs7 tka3naed w+nrwal camract« C67-717510 <br /> owe 188 REV,t/2o06 Date 51 tied C•57License Number <br /> IF AOOITtONgL bPACE le NEIIIED,U9E NFxT CONBBCUTIVELY NUMBERW FORM <br />