Laserfiche WebLink
ORIGINAL STATE OF CALIFORNIA R USE ONLY — D FitL101 <br /> File with DWR WELL COMPLETION REPORT <br /> Page l of Refer to Insiruciton Pampblei STATE WELL NO rSTAPON No <br /> Owner's Well No U r I g No 533628 LATITUDE [I ❑ <br /> Date Work Began It ,3 OV Ended 1( B/P LONGITUDE <br /> Local Permit AgencN ca r. v h C <br /> . Permit No zi{_33f� Permit Date 10 11-7 <br /> APNITRSIOTHER <br /> GEOLOGIC LOG �)/1 Er WELL OWNER <br /> ORIENTATION ► VERTICAL _ HORIZONTAL -� ANGLE _(SPECIFY) Name v h0 l <br /> DEPTH TO FIRST WATER (Ft) BELOW' SURFACE Mailing A dress <br /> DEPTH FROM res <br /> SURFACE DESCRIPTION l <br /> Ft to F1 Describe material ,grain size color etc CITY W <br /> WELL L O CATION STATE ZIP l <br /> ^ Address V 51 F.;4,w6t <br /> we0 L)-Iq Citi <br /> Counh <br /> APN Book Page Parcel <br /> Or <br /> Township Range Section <br /> Latitude__ NORTH Longitude I WEST <br /> DEG MIN SEC DEG MIN SEC <br /> LOCATION SKETCH -TIVITY <br /> NORTH _NEW WELL <br /> MODIFICARONIREPAIR <br /> i .�Deepen <br /> Other(Specdy) 1 <br /> i <br /> DESTROY(Describe <br /> Peoeedwss end Materisls <br /> Under GEOLOGWCLOG) <br /> PLANNED USE(S)- <br /> w a (-' 1 <br /> w MONITORING <br /> r r � <br /> 1 WATER SUPPLY <br /> i ► <br /> paneahc <br /> Pab4c <br /> � I <br /> Irrigation <br /> IndepnaY <br /> TEST WELL <br /> CATHODIC PROTEC <br /> SOUTH TION <br /> Illustrate or Describe Distance of Well from Landmarks — OTHER(Speedy) <br /> such as Roads Buildings Fences Ricers etc I <br /> PLEASE BE ACCURATE & COMPLETE <br /> DRILLING <br /> METHOD FLUID <br /> WATER LEVEL 6 YIELD OF COMPLETED 14 ELL <br /> DEPTH OF STATIC 26'.112 11 I /t�eo <br /> WATER LEVEL (Ft) & DATE MEASURED r <br /> ESTIMATED YIELD' (GPM) d TEST TYPE <br /> TOTAL DEPTH OF BORING (Feet) TEST LENGTH (Hrs) TOTAL DRAWDOWN (Ft) <br /> TOTAL DEPTH OF COMPLETED WELL 60 (Feet) •Mav not be representative of a well!t long-term veld <br /> DEPTH CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE BORE TYPE ✓ FROM SURFACE TYPE <br /> HOLE — <br /> INTERNAL GAUGE SLOT SIZE <br /> DIA ,c z m MATERIAL/ CE BEN <br /> (Inches) FILTER PACK <br /> z z. DIAMETER OR WALL IF ANY <br /> 4 Q e GRADE MENT TDNITE FILL <br /> Ft to Ft io v c+o � (Inches) THICKNESS {ineheal Ft to F1 (� ) (� ) (� ) (TYPE/SIZE) <br /> D 70 8 ✓ I rpvc. -z c 0 0 64 ✓ <br /> 70 6 1V1 PVC- 25 <br /> q0 U 020 S ✓ <br /> 68 80 # <br /> ATTACHMENTS (:) CERTIFICATION STATEMENT <br /> GeologrcLOU I the undersigned c1errtify that thus report is complete and accurate to the best of my knowledge and belief <br /> — Well Construction Diagram NAME re s CrsD� Uhl 1 t�t <br /> (PERSON FIRM OR CORPORATION) (TYPED PRINTED) <br /> Geophysical Lop(a) /� �� ��r _+� <br /> Soil/Water Chemical Analyses t 3Z CL(�. �Y STATE `q Zip <br /> ADDRESS <br /> — Other <br /> ATTACH ADDIT OVAL INFORMATION IF IT EXISTS Signed '"' Y (2�_ -71 Siv <br /> WEL RILEER/AOTNgRIZED SENTAT E DATE SIGNED C 57 UUNSE NIIM8ER <br /> DWR 188 REV 7 go IF ADDITIONAL SPACE IS NEEDED USE NEXT CONSECUTIVELY NUMBERED FORM <br />