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OTIGINAL STATE OF CALIFORNIA Y — 0 xT <br /> A <br /> File With <br /> f� <br /> h DWR WELL COMPLETION REPORT <br /> rrage <br /> o _ P <br /> POK a�----L. lgefer to I„serast:ore Pam bier BTATt WELL NQt$TAT1t7N NO <br /> Owner's Wen Na 1A.1—7 No ji q <br /> Date Work Began ,C{l�1_��T� _,Ended�r�.�e�/ 1 73 LAniuos � LONGMME': <br /> • <br /> Local Permit Agency�-r lr,_�OU.,4,. ,azj,� Ze. a i <br /> Pe o ll Q !P-3 f <br /> Permit AIO - _Permrt bate <br /> GTOLOGiC LOG t TELL OWNEU <br /> ORIEPNTAnON AL _140MONTAL —ANGLE ..,..._..(6Pt2c" Na" �I `1C.004-0- r <br /> OePry F DEF M TO FMW wA79Et (Ft:)13RDIV SURFACE Meu Sri Addj= a, - d <br /> $ugPACE §CRIPTION ,�ti • i ` a <br /> F1 la FL De Ae retrnaf om size,rolor ac.. , WELI.r I,�CATION STATE ZIP <br /> J r dity <br /> e , <br /> tiG'ntlnkydi tel <br /> Al_f ' APlq Bonk page Parcel <br /> or <br /> � � � TD► rp�_AaA,ye��Seotinre <br /> 'mek LatAaell '471 JJOaTIt 423 wry <br /> Longitude IRI,r o�oZ, <br /> DEMIKBEC. 13EM NW. SEc <br /> LOCATION SKETCH ACTIVITY (!) <br /> NTH ..._.NEw wr,I.J. <br /> 'YS' for •`.` 5 fVaunf Fao))ry� aT ov7f, ,f Gk `z3; <br /> MOO>FIcAnONMEPAm <br /> aa■ <br /> Other(Specify) <br /> CiAe <br /> t r �- R�.`C9 TROY fJ!■acrrbr <br /> µ' PLANNED USE(S) <br /> a e1 <br /> t f <br /> __._ wtOturaRuan <br /> wnTart SUPPLY <br /> r , <br /> . M ,�, Dwrreallo <br /> r , <br /> y PubFc <br /> 1e12ur64ui <br /> , <br /> _ -TEST WELL <br /> e SOUTH o NOotC PRgTEG <br /> Tllrurmrp cr Deaerlbe Ot,tance of Well from La„dmarin —oTFIE3l Oyaedryy <br /> , , :arch ar Aoads, <br /> PL8ulda!lr�a FeruxA)tfsers eta <br /> EASE 8$ ACCUAtA G COMPLETE <br /> r DRILLING <br /> METHOD ,I FLUID <br /> WATER LINEL tt YIELD OF COMPLETED WELL <br /> i DEPTH OF STATIC <br /> WATER LEVEL (FL) a DATE M1EA8URED <br /> ES IMATEU YIELD (GPM) A TEST TYPE: <br /> TOTAL DEPTH OT' BOWNiG ay (IreLt) TEST LENGTH (Era) TOTAL ORAWDOWN WI) <br /> TOTAL DEnIf Ole COMPLETED WELL (Feet) •May tier be representa xe of a vcfl J lon"erm yield— <br /> DEPTH CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE SLE TYPE W FROM SWFACE TYPe <br /> DIA_ .1§ fATEFILALI INTERNAL GAUGE SLOT SIZE OE- kTEN <br /> (4FtADE DIAME1 OR WALL V ANY PACK <br /> to Ft ER <br /> Ft dachas) $ (Moheay TFUCIO(ESS ltacba■J FI W Ft MEANT TORITE FILL FitT <br /> R { 1 { j (r trrt'Etatxe) <br /> , <br /> ATTACHMENTS CERTIFICATION STATEMENT <br /> Gookwo Lou 1,the undersigned,certify that this report is cco-mplete and accurate to the beef of my knowledge and belief <br /> Wet$Coasbmmalt Wagratn molue j Q&/C J���' '✓ <br /> (iaephYaroal Log(a) <br /> (PUMN REIF.Oa COMPORRTION) OR PRINTED) �dllw7 <br /> Etch/Water Chemical Aaelysas r ,G r s -75-- l ✓ TTL <br /> PDDR <br /> Other My STATE ar <br /> rITTAI,41 <br /> D12MCWAL INFOAMATIOPR Jr JT EXISTS Slenet! � I� �'� q <br /> 41?A T rp RE—M VE Ile&8 NED G67 E <br /> DWR188RgV 740 IF ADDIMONAL SPACE 1S N 651). USE NEXT CONSECUTIVELY NUMBERED FORM <br />