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w w h + <br /> ' H <br /> ,eGINAI. STATE OF CALIFORNIA t <br /> '� with <br /> WR WELL COMPLETION REPORT 4At <br /> ted' Page of Re/er io Inttructron Pamphlet STATE WELL 140 ftiTATION NO <br /> Owner's Well No No I. � � � <br /> Date Work$egan � Ended 562295 LATITuoE LONGITUDE <br /> `oval Permit Agency -Sg <br /> ' Permit No Permit Date APNITRSIOTHgR <br /> GEOLOGIC LOG W LL OWNER <br /> EIENPAN i�) VERTICAL — HORIZONTAL ANGLE —(SPECIFY) Namt.oFwrtl To F[)t5T wkTER_ 74 M) BELOW SURFACeMallin Address �r4OME DESCRIPTION <br /> ce <br /> o Ft Derenbe matmal gTain size,coli,etc QTY SATE p <br /> s L WE L LO JILTION <br /> Address a C (v <br /> ' <br /> , City G <br /> m <br /> ' L 't County S'G't O <br /> AP N Hook Page Parcel 11 <br /> Township h Range Section <br /> LatitudeNORTH Longitude we° <br /> DEG MIN SEC_ DEG MIN SEC <br /> LOCATION SKETCH ACTIVITY (�) <br /> ' NORTH _ �( <br /> sY NEW WELL <br /> ' f . 1 MODIFICATION/REPAIR <br /> 1 <br /> . , <br /> i -Deepen <br /> CI/ ss�rr,� <br /> -Other(Spec,ty) <br /> 9.4 <br /> 're+.�. I ILl �v <br /> iP <br /> DESTROY <br /> cedureatas ndUaens <br /> , >p t Under GEOLOGICLOG <br /> , r I PLANNED USES <br /> u1 x MONITORING <br /> WATER SUPPLY <br /> V C� t 1 — Domestic <br /> ' ' E r � �t� +1 � — Public <br /> 0 7 ?, _ Irrigation <br /> Q F L', �` _ Industrial <br /> ^ u L e)(347 its A 1 TEST WELL <br /> ' SOUTH ^-• CATHODIC PROTEC <br /> ' I Illustrate or[Jest OTHER <br /> rild Dutaen of Wel!from Landmarks _ OTHER(Speclty) <br /> ' such as Roads 8uifdmga Fences lt:uers etc <br /> PLEASE BE ACCUTtATE Lr COMPLETE <br /> DRILLING <br /> METHOD Z L4- FLUID LC� <br /> WATER LEVEL & YIELD OF COMPLETED WELL <br />' DEPTH OF STAnc <br /> F <br /> WATER LEVEL(Ft) 8 DATE MEASURED <br /> ESTEMATED YIELD* (GPi,A) & TEST TYPE <br /> TOTAL DEPTH OF BORING 9?:�` (Feet) TEST LENGTH (Hrg) TOTAL DRAWDOWN (Ft) <br /> TOTAL DEPTH OF COMPLETED WELL_ (Feet) *May not be representative of a well's long-term yield <br /> DEPTH CASINC(S)_ _ _ _ _ <br /> BORE- ----DEPTH —ANNULAR—MATERIAL— <br />' <br /> --—FROM-SURFACE— HOLE TYPE � FROM SURFACE DIA C a MATERIAL/ INTERNAL GAUGE SLOT SIZE TYPE <br /> Ft to Ft (!oche") 5 lip <br /> a GRADE DIAMETER OR WALL IF ANY CE NN <br /> m y u= <br /> Onchea) THICKNESS finches) Ft to FE MENT TOHITE FILL FILTER PACK <br /> (i) (�) (I} (TYPE/SIZE) <br /> 8 e- <br /> XFT_ <br /> y+� © 0 <br /> , <br /> ....................... <br /> ATTACHMENTS (✓) CERTIFICATION STATEMENT <br /> Georogic Log 1,the undersigned certify that this report Is Complete and accurate to the best at my knowledge and belief <br /> Woll Construction Diagram NAAAE ! <br /> —.- GeoAhysical Log(a) (ARSON OR CORPORATION) (T ED OR PRINTED) <br /> Soot Water Chemical Analyses 950 Howe Road Martinez CA 94553 <br />' ADDRESS CITY STATE Z1P <br /> _ other o <br /> ATTALYI ADDMONAL INFORMATION IF tr 1:XlSTS Signer T 485165 <br /> WELL OR THORI E DATE SIGNED ��Z 5T LICENSE NumaER <br /> T)WIi1t3AREV 7-!)D IF AI'll�1Tl(1NA1 CPA(`t= IC r.ircntn iter ucvr .... .r .. ......�_ �__ <br />