Laserfiche WebLink
ORIGINAL STATE OF CALEFOR\Eq DWR USE ONLY — DO NOT FILL IN <br /> File with DWR1 WELL COMPLETION REPORT <br /> Page 1 of—L- Re fi r to Iattr+rct+on Pa++phle f STATE WELL NO(STATION NO <br /> Owner's Well No L)— 1� No 729678 <br /> D tte 11 of k Beg in 10 06 0'd Ended /o 10 O'D LATITUDE LONGITUDE <br /> • LOC'il Permit Aecienci. 4 4 6ix <br /> Permit No Permit Date to L " APNlTRSIOTHER <br /> GEOLOGIC LOG NVELL OWNER <br /> ORIENTATION (✓) VERTICAL _HORIZONTAL _ANGLE _(SPECIFY} Naille <br /> DRILLING �7 /1 Ma hit 1c1 lreu <br /> DEPTH FROM METHOD �'[ FLUID r, <br /> SURFACE DESCRIPTION G (, vrf <br /> FI to Ft D(5(I do mate)irrl ,jam ttz( (Idol (f( CITY STATE ZIP <br /> O 13 C -7 �. v ELL Loc ION <br /> Address <br /> 15 1 Cit1 �+ <br /> IS 2- 5 ' CountN +. <br /> 2 3 AP\ Boob Page Par(-LI <br /> 38 �� i t 4 Township Range Section <br /> 3� L ttitude_ i I NORTH LOnglttich I I WEST <br /> DEG MIN SEC DEG MIN SEC <br /> t LOCATION SKETCHTIIITI I:) <br /> NORTH Vl"NEW WELL <br /> 6 MODIFICATIOWREPAIR <br /> 6A 7.1 S <br /> — Deepen <br /> -7-3 65 s, -b w other(SpecrlYi <br /> &'3 I Co 3 5t 1 <br /> (� _ DESTROY(0 e <br /> i115 21 U Im 19 V1 Procedures andd Materials I <br /> Under GEOLOGIC LOG )I <br /> 111 lie S. �� d PLA\NED LSES (.�L) I <br /> � I <br /> I _ j t WATER SUPPLY <br /> i I o Domestic Public <br /> y„ Irrigation Industrial <br /> J H <br /> r '� w MONITORING <br /> (q} <br /> TEST WELL_ <br /> I I ^IS CATHODIC PROTECTION <br /> �,p HEAT EXCHANGE <br /> fA /• We DIRECT PUSH <br /> INJECTION <br /> VAPOR EXTRACTION I <br /> SPARGING <br /> i I 5 UTH REMEDIATION_ <br /> 111i15l rale o+ 11 unhe 1J+�1u+ue of 11cl1 from Rnar1. Bnildu+1, <br /> I !•r m I s R; r+� r It raul attach a uu++ t a eiddif owd Inger rr OTHER(SPECIFY)_ <br /> nc r r+�r11 q PLEASE BE ALL L RATE c:COWPLEA <br /> 11 ATER LEN EL & IIELD OF COMPLETED II ELL <br /> I <br /> DEPTH TO FIRST WATER 26 0?tFt) BELOW SURFACE <br /> DEPTH OF STATIC <br /> WATER LEVEL 26.56 (Ft)&DATE MEASURED <br /> ESTIMATED YIELD (GPM) & TEST TYPE _I <br /> TOT1L DEPTII OF 130RI\( {F,,tl TEST LENGTH (Hrs) TOTAL DRAWDOWN (Ft) <br /> TOT Ni. DF111711 OF (OMPLFT£D NI ELL U_8 IFe(tl " Ih7v not be fepieeenratr,e of a z,ell r long-terra Iirld <br /> DEPTH BORE CASING (S) DEPTH AN\ULAR NIATERIAL <br /> FROM SURFACE HOLE TYPE() FROM SURFACE TYPE <br /> DIA x w g MATERIAL INTERNAL GAUGE SLOT SIZE CE BEN <br /> Unchesl g w za GRADE DIAMETER OR WALL IF ANY MENT TONITE FILL FILTER PACK <br /> Ft to FI m -1 <br /> - (Inches) THICKNESS pnchesl Ft to F1 ( � ) { � ) { � ) (TYPEl51ZE) <br /> LL <br /> oa ✓ I vG z 5D, q0 0 JOS <br /> 08 118 6 2vc- Z qQ a to z0 14'2— 106 <br /> I06 t 1 e. I <br /> ' I <br /> I <br /> ITTA(HNIENTS CERTIFICATION STATENIENT <br /> Geologic Log <br /> I the Undersigned certify that this report Is complete and accurate to the best of my knowledge and belief <br /> s <br /> — <br /> Well Construction Diagram !NAME DIM kv <br /> (PERSON FIRM OR CORPORATION) {TYPED OR PR RF <br /> Geophysical Logs} (PERSON <br /> SoillWater Chemical Analyses I`G CapAwoLC/N (S-iq2 <br /> Other ADDRESS CITY STATE ZIP <br /> - L2 7 `j S7rG I <br /> ATTACH ADDITIONAL INFORMATION IF IT EXISTS S+gned <br /> WELL DRILLERIAU ORIZEO REP S ATIVE GATE SIGNED C 57 LICENSE NUMBER 1 <br /> IM11 ISS BEN a v- IF ADDITIONAL SPACE IS NEEDED USE NEXT CONSECUTIVELY NUMBERED FORM <br />