Laserfiche WebLink
O,RlGINAL STATE OF CALIFORNIANOT F <br /> fU'wltn S WR WELL COMPLETION REPORT 0. 1" <br /> Page—of Refer to Instruction Pamphlet "STA WELL NO.lSTATION NO. <br /> Owner's Well No. No. 562295 <br /> i <br /> Date Work Began gW 2s— Elided LATTRIDE LONGITUDE <br /> '.veal Permit Agency Sqz% iD I I I t I t I I I 1't I <br /> Permit No. Permit Date y — <br />+ ' " GEOLOGIC LOG _ .W. LL OWNER <br /> 7 ORIENTATION _X_VERTICAL _ HORIZONTAL ANGLE (SPECIFY) Name <br /> IlY DEPTH TO FIRST WATER--7-0—(FL) BELOW SURFACE 'Mailing Address <br /> DEPTH FROM <br /> SURFACE DESCRIPTION <br /> Ft, to ft. Describe material, CITY <br /> - SATE ZIP <br /> ain size,color,etc. WELL LO A T I O " <br /> Address � - G "e A- <br /> cw <br /> L � � County <br /> 4 �� - APN Book Page Parcel <br /> or r <br /> ^ Townshep�/ Range - Section <br /> s o .f. - `" or NORTH <br /> t Latitude Longitude t WE <br /> DEG. MIN. SEC. DEG. MIN- SEC.' <br /> LOCATION SKETCH ACTIVITY?(f) <br /> f ).. ��" NORTH_ _ i <br /> 1 NEW WELL <br /> MODIFICATION IREPAIR <br /> I.. t <br /> _.._Deepen. <br /> tsse-hi � <br /> -, .� , F - Diner(Specify) <br /> I 4 <br /> DESTROY Wasodbe <br /> Procedures end Materi, <br /> tinder"GEOLOGICLOt <br /> I- PLANNED 6E(S <br /> _. MLu <br /> DNITORING <br /> 1j.cJj/(��} WATER SUPPLY <br /> 1 SA Domestic <br /> O <br /> I ' _ Public <br /> l d 8 r i) <br /> ' A I� � Irrigation7 ) � 'e <br /> / — industrial <br /> ' 1 L f •TEST WELL" <br /> f � I CATHODIC PROTEI <br /> i SOUTH TION P <br /> fllwirafe or Describe Distance of Well from Landmarks _ OTHER(Specify) <br /> such as Roads,Buildings,Fences.Rivers,etc. <br /> PLEASE BE ACCURATE 0 COMPLETE. <br /> DRILLING <br /> METHOD _11 e;- FLUID Ll�//per <br /> -&_ <br /> ( WATER LEVEL & YIELD OF COMPLETED WELL <br /> DEPTH OF STATIC �t <br /> t {Ft.) 8 DATE MEASURED <br /> WATER LEVEL x <br /> " ESTIMATED YIELD (GPM) & TEST TYPE <br /> TOTAL DEPTH OF BORING (Feet) TEST LENGTH (Hrs.) TOTAL DRAWDOWN (FL) <br /> TOTAL DEPTH OF COMPLETED WELL� � (Feet) ""May not be representative of a well'r long-term yield. <br /> DEPTH CASING(S) ANNULAR ,MATERIAL <br /> FROM SURFACE BORE- DEPTH <br /> HOLE TYPE t I FROM SURFACE TYPE <br /> INTERNAL GAUGE SLOT SIZE <br /> (inOches) c N MATERIAL/GRADE DIAMETER OR WALL 3F ANY CE BEN. FILTER PACK <br /> 4 Ft. to Ft. U (Inches) THICKNESS MENT TONITE FILL <br /> a h c w ilnchas) Ft. to Ft. (TYPElSIZE) <br /> D <br /> j <br /> e c D Or 01/1_ <br /> r <br /> ATTACHMENTS f <br /> (--) CERTIFICATION STATEMENT ) <br /> Geologic Lop <br /> I,the undersigned,certify that this report is complete and accurate to the best of my Isnowiedge and belief. <br /> Well Construction Diagram NAME <br /> f Geophysical Log(3) "( 6R CORPDRATION) (T ED Off PRINTED) <br /> 950 How Road Martinez CA 94553 <br /> SoAtWater Chemical Analyses <br /> ADDRESS CITY STATE zip <br /> — <br /> Other q - 485,165 <br /> ArrAc►f ADamotYAL INFORMATION. IF IT Exists. Signed <br /> WELL FHDRf ED ES GATE SIGNED G57 LICEk$E NUMBER <br /> DWRINREV.7-90 IF ADDITIONAL SPACE IS NEEDED, USE NEXT CONSECUTIVELY NUMBERED FORM ti" <br />