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' -PAIGINAL STATE OF CALIFORNIA 149 9NI.X, <br /> File '" DwR WELL COMPLETION REPORT <br /> Page Qf Refer to Instr«ctron Pamphlet STATE WELL NO1STATION NO <br /> SEZ <br /> ❑ L <br /> Owner's Well No -�� No [� <br /> Date Work Began Ended J LATMUDE LONGmtDE <br /> Local Permit Agency. a _t __1_ 1 - 1 1 1 1 1 1 I I I t <br /> Permit No Permit Date ' ! <br /> GEOLOGIC LOC WELL OWNER <br /> ORIENTATION (!:L) 14V VERTICAL _ HORIZONTAL —ANGLE — (SPECIFY) Name <br /> DEPTH FROM DEMI TO FIRST WATER-70_(FL) BELOW !,U11 kCE Mailing_Aqdress 7Sd•i r ' <br /> SURFACE DESCRIPTION a <br /> Ft t0 Ft Descnbd rnateml,gram uze,color,etc CITY STATE ZIP <br /> WELL XCATION <br /> Address Q 1.2 1 Sd Az,a ✓ <br /> 1 Cit} <br /> t i <br /> County <br /> 4PN Book 7q Page�Parcel Je <br /> w� 7_6 + 1 4 1I r ) } or <br /> t r� Towanship Z&Range oA?Y Section <br /> Latitude I I NORTH Longtfude— --, _ WES <br /> DEG MIN SEC DEG MIN $EC <br /> ` LOCATION SKETCH ACTIVITY {�}- <br /> NORTH NEW WELL <br /> K <br /> MODIFICATION/REPAIR <br /> a �SSL'+r�61y _..Deepen <br /> f S�dp —Other(Specify) <br /> DESTROY(Describe <br /> ^,� Procedures and Material <br /> WO_ .S--M W a, ^Z Under GEOLOOICLOO <br /> PLANNED USE(S) <br /> �75 in to <br /> 31 r W _x MONUORING <br /> � WATER SUPPLY <br /> Sit oe _ Domestic <br /> 1 v <br /> i t J ___. Public <br /> Irrigation <br /> ' t �r _ Industrial <br /> S TEST WELL <br /> { SOUTH CATHTION ODIC PROTEC <br /> Illw9rate or Describe Instance of 6L ell from Landniatks __ DTHER(specify) <br /> such as Roads Butldsrtgs fences Ricers etc <br /> z + <br /> PLEASE BE 4CCIIRArE & COMPLETE <br /> RRILLING <br /> ' METHOD FLUID <br /> WATER` EVEL & YIELD OF COMPLETED WELL <br /> ' DEPTH OF STATIC <br /> WATER LEVEL _- 71 (Ft) & DATE MEASURED <br /> ESTIMATED YIELD` (GPM) & TEST TYPE <br /> TOTAL DEPTH OF BORING (Feet) TEST LENGTH (Hrs) TOTAL DRAWDOWN (Ft) <br /> ' TOTAL. DEPTH OF COMPLETED WELL (Feet} 'May not be representative of a welt'r long-term yield <br /> __DEPS _ CASINGS) DEPTH ANNULAR UATER11L <br /> FROM SURFACE HORS_ TYPE ✓ I FROM SURFACE TYPE <br /> ' INTERNAL GAUGE SLOT SIZE <br /> DIA z � a MATERfAL! CE BEN <br /> (Inches) < op GRADE DIAMETER OR WALL IF ANY MENT TONITE FILL FILTER PACK <br /> Ft to Ft m coo W (Inches) THICKNESS (Inches) Ft to Ft (� ) {� ) (� ) (TYPEISIZE) <br /> Pile- ' <br /> 1 <br /> 63 y zmz*� <br /> 3 i <br /> ------------- <br /> 1 <br /> (ATTACHMENTS CERTIFICATION ST4TEMENT <br /> Geologic Log I,the undersigned certify that this report Is complete and accurate to the best of my knowtedge and belief <br /> r X Well Construction Diagram NAMEling & Testing, Inc. ) <br /> — GeophysicalLog(s) (PERSON FIM OA CORPORATION) (TYPED OR PRINTED) <br /> SoillWaterCherruCatAnelyees owe D Martinez CA 94553 <br /> ' ADDREsil <br /> CITY — STATE LP <br /> — Other 485165 <br /> ATTACH ADAITTONAL INFOpAIATION IF IT EX1SrS Signed <br /> WELL DRI LLER A 0 REPRESEN PATE SIGNED Car LICENSE NUMBER <br /> PWR IAA RFV 7 go IF ADDITIONAL SPACE IS NEEDED USE NEXT CONSECUTIVELY NUMBERED FORM <br />