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' <br /> "02 <br /> UAlG1 L STATS OF CALUOEARA W u e N Y N <br /> rFil6 W'i�h DW d <br /> wELL comymiroN REPoRT O d <br /> 1 f Page-Lo Refer soI=HvcttorA�PampHitt aTATEWELLM TAT 4 <br />' Owner'ad/Well N% Na. G G O ❑ <br /> Date Work Began KA , Ended azi! urtr+rrse LprtclTUOE <br /> Local Permit Agent+ <br />' <br /> Permit Na UUl&7 PertnttDate /� <br /> GEOLOGIC LDC WELL OWNER <br /> ORIENTAT1DN V} _vM+TICAL _WK20WAL _AMIX COPED" Narrte'• ,, j �a�2r',d x77" <br /> rnseM TO FIIIST INATf11 (A)II ELOW=FACE Mailing Address j* <br />' Da�URACE DESCRIPTION PH" ` (' ;` <br /> <S` .•', s <br /> FF to Ft De—be wwaA ad-,ere �`, , Gt7Y , ' .k >• i � STATE 31P <br /> WELL-bgCATION <br /> ' CD4nt-Y <br /> �APN Book Page Parse! 222 <br /> ' 1 `,'` 1' w` t' +� a '�• �4 Range Sectim <br /> �; t '1 iat3tud'e oso 1'Mui seats I'° e OEM = Mw I WEST <br /> sec <br /> LOCATIOiv SAETCH +J�CTIYITY(4) <br /> �7[ <br /> 1 I i ! l • �♦ <br /> NORTH N6w wa-L <br />' 1 Y- NtOWFICl1ilON7H6PA8i <br /> 1 1 ~ 1' Y •I �•I <br /> l 1 5 �• <br /> Othrr(apocgy) <br />' ' 1 •; s T DESTROY�eMealtra <br /> Ul <br />' 3 <br /> .5 J 5. HOMit4RW9 <br /> 1 1 / <br /> WATM SUPMY <br /> 1 , l" _ J oomwhc <br /> j 1 e <br /> I/rlQittl7/1 <br /> 1 f <br /> *IM why <br /> 1 1 CATHODIC PRO= <br /> ' f / /lhratrafe or OGfmha 131slarlcx of ti4aR from Imtdrnarita ._._.CiTFtER(SPidiy) <br /> tush at Ronda,9arfdingt Faece7 R atG <br /> PLEASE HE ACCZ7R4tTC tr COMpI Ark <br /> DRILUNG <br /> WATER pLEVEL is YULD OF COMI'I.ETED IVEL14 <br /> f DEPTH OF STA7fCIragURl7] <br /> 7 �Z Z <br /> WATER LEVET. (FI) a DATE MEAS <br /> ' 1 ESTIMATED YIELD (CiPM) 8 TIEST TYPS <br />' TOTAL Di~4'M OF (Fast) TEST LENQ7M 011m) TOTAL DRAWDOWN SFt) <br /> TOTAL tT[SPm OF GObII'i.E w VVmL to t) "May net be reprrsie=Mc of a WW'I lmug-wm yr d& <br />' us" CASING(S) no" AiVN11LAR MATI&RIAL <br /> FROM SUMACE TYPE ✓ FROU"FACE TYPE <br /> DIA w INTERNAL 13AUGE SLOT'SIZE <br /> c d MATERIAL/ DI R OR WALL IF ANY nCE- <br /> 39 FILTl PACK <br /> FI to � e RADE OwbeM THrXNESS (anilas) Ft to Ft 70N� F 1 (T1,PE/elx <br /> p Pee _Z- .716##AV a <br /> t' JD 17-0 if pive, <br /> / <br /> l <br /> 1 1 1 <br /> 1 / <br /> 1 1 <br /> ATT10MENTS (4) CERTIFICATION STATEMZNT <br />' 01"En Leo 1,the undersigned,certify that this report Is complete and accurate to the beat of rey knowledge and belief <br /> WON cemuoetwn 0SWOM MA1u6 16111V SZ92969M e&& X4=&t9-A GI-1d <br /> t�eaphyateal Log(a} M=H•MK an caROPATKM (T11=os IED) <br /> trw.a�c> �.t Amba.. �f �/ J Ll.S 7 <br /> ZOO �� �s9A�-- Coy s ST.T � <br /> ATTAGf ADOWDUAL NIFORM77t]M Sr-IT WSTS S1pnlld f UTNE Qn�4-4w.01 - rr!7� . <br />' DWa mo,,v 7.80 1F AOOITiONAL SPACE i EOED, USE AV CONSECUTIVELY NUMBERED FORM <br />