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041GINAL STATE OF CALIFORNIA N -T FILLAN <br /> rFtle w'i�h DVI! <br /> WELL COMPLETION REPORT � � � <br /> r Page—I—pE a Retry eo Instratt,on pArttaphiel $TATE WELL.mvsTAT16D 1a <br /> Owner's'weil No, °" No. 422984 <br /> Date Work Began « 7,1 ,ended Z r! LATrMOE L.ONGnVUE <br /> • Local Permit Agency <br /> Permit No, l�Of�7 Permit Date /ja <br /> GEOLOGIC LOG WELL OWNER <br /> OREENTATIpN [f} _VERTICAL —HDRRONTAL _AMLE _(SPECIFY) Nante` %' ' p� ra <br /> ` <br /> �10 <br /> DBPT'!FT TO FIRST'WATER—(FL)BELow SURFACE Mai�Lg Add�e�s <br /> DESCRIPTION {`'ti -�•' '% <br /> pu-fn am �r eta `` � CITY , t r STATE ZIP <br /> �'` WELL, -QCAT`ION <br /> APN Hoak Page o Parcel <br /> FonQr�rialnP,—Range Section j <br /> _ Z,It�jtude F F NaAme Longitude wEST � <br /> Dam MEN. SEC DEM MIN Mc i <br /> F , , LOCATION SKETCR ITT <br /> NORTH <br /> (�) <br /> " ` t NORTH _�[_ <br /> • W WE3.1- <br /> MODFFWATIOWHEPAIA <br /> Deepen <br /> Other(SpwVy) <br /> PMG0nE9TA0YloearMaf <br /> Under OaXO MetsdaAl <br /> Under Gfasac/csoa") <br /> ' PLAAAD USE(S)— <br /> LU (�) <br /> MFNaToMNo <br /> A� <br /> WATEA SUPPLY <br /> F , <br /> • T Dog1NIFc <br /> 1 , Pahia <br /> Fnduatrlal <br /> , <br /> _._. '`TESr wiaL, <br /> CATWSOUTH 'no" PROTEC <br /> Vastrole or Describe Diatance of Well from landmarks QTHPR(Spearly) <br /> such as Roads,Batldfnes panels Rio etc <br /> , F <br /> .PLEASE BS ACCVRAR& CUMPIXM <br /> DRILLING <br /> k4ETHOO r +(YY I7 JCEL AOMet' <br /> WATER LEVEL Ar YIELD OF COMPLETED WELT, <br /> DEPTH OF STATIC �} <br /> ' WATER LEVEL -Is 17 (Ft) A DATE MEASURED ZZ-AZ <br /> ESTIMATED YIELD (OPM) a Tr;ST TYF>= <br /> TOTAL D13PT>;I OF BORING �Zr (Feet) TEST LENGTH 01m) TOTAL DRAWDOWN( (Ft) <br /> TOTAL DEPTIT OF COMPLE ED WFLL A-9 O (Feet) •May not be represetr amm of a welf r long-term J-1d. <br /> DEPTH CASING(S) DEPTH ANNULAR MATERXAL <br /> FROM SURFACE 9oltE- TYPE ✓ FROM SURFACE <br /> DIAHOLD ,� z d MATERIAL/ IRTERNAL GAUGE SLOT SIZE TYPE <br /> DIAMETER OR WAIL IF ANY GE- BEAT- FILTER PACK <br /> Ft to Ft Oneuss) GRADE MENT TONIfE FILL <br /> „ Onche4 THICKNESS 00"") Fl to Ft (1YPEJSCCE) <br /> (`4) ('C) (L') <br /> 14 20 03 q 1pva .y- 3Ci v .&/0 <br /> zo, <br /> t <br /> F , <br /> t <br /> TTACHMENTS (4) CERTIFICATION STATEMENT <br /> Falogia Lag 1,the underalgoad,certify that this report Is completeand accurate to the boat of cry knowledge and belief <br /> _„_, Wan conetm lion Diaomm NAME 1v4� e-4 0 +114rA ^ Ae,1,e7e <br /> • <br /> iieaplyslcelLoO(e) (FUMON FIRM OR CD PMAnON) (TYPED OS IED) <br /> J-041r i� 10- AWA-019 <br /> BIWAtOTQWWOulAnaryeeye # J,� AODIIFSS CITY STAI 21P <br /> B 9 <br /> A7TACFi ADADTONAL tFu>aateArJoAL D (7 G7R3)3 waned 0 fL L D OMESMATIYE C,57 L S FR <br /> DWRlea 8xv 7-00 IF ADDITIONAL SPACE ( EFEDED, USE AEXT CONSECUTIVELY NUMBED r-opw tsOr �� <br />