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' ORIGINAL y ' STATE OF CALWORNIA Mte- <br /> Fine with DWl� WELL COMPLETION REPORT r <br /> Page Of I W Refer to Ixurnettan Pawpblet STA WELL O/S NO ❑ <br />' Owner's Well Me. "* No. C:1Z A '3 ,y <br /> Date Work Began E e V v`1YljbA nmuae Lonr3rnme <br /> Lace]Permit Agee • Ili t' r <br />' Pe=t No Permit Date <br /> GEOLOGIC LOG + WHL 11,14FA---- <br /> ORIENTATION {✓} ?L vEm oAL _,..,wx ronTAL AwLE —iwmam Noute � <br /> EFpTFt FROM DEp173 TO FHLST WATER—M)BELOW SURFACE 1 tg A 'LYZnt <br />' anRpM� DESCRIPTION •; ' { • r' I <br /> Ft to Ft nrnraral talaer u� ` ` ''•� 1 STATE MP <br /> I.L,rIO AxI�d <br /> I , 'Ad¢rc�s <br /> 1 <br /> 1 ' 1 <br /> � eC' IrD county 2241 <br /> AFN Book PagW Pure, <br /> 1 s Tow�daltip Range section <br /> _ _ ,Lallde n (i ItI Sty eom Longitude s + W SEM WEaT <br /> 1 I n ti <br /> 1 1 C I , " <br /> s y y , LOCATION SKETCH ACTIVITY ({} <br /> 1 e . NORTIJ NEW WELL <br /> fum �" unnIF1CA71dM//IEPA¢i <br /> •TV Deepen <br /> ' ��I t t °L •!{ + ] �otllar csaoQlm <br />' i 1 1 , , ( OE9TROY IO�CYlhe' <br /> 1 I ArOCefllllef MdAtglellatS <br /> a {Jh�lde VEEOLOQI MS-) <br /> 1 1 TI m PLAN <br /> NRD USE(S)- <br /> 1 1 � � � (htaFxTntm�Is <br /> 1 <br /> 4- <br /> 1 WATER 917pPf.Y 1 <br /> 1 I <br /> ..--, Domaetla <br /> 1 l <br /> �.. P'ntlllc <br /> i 1 <br /> — 1 �, IIIrG�Ilaf{ <br /> 1 1 <br /> I 1 <br /> .,,�� klduaMat <br /> 7 J <br /> -TFa7'S1lrll <br /> 1 <br /> SOUTH IT MMC PROTfiG <br /> 1 ' Illwfute ar Derttl8e Dglaars of SVt'!!fmm Landmarks -�47tIFA(9parlfy) <br /> r .+ncl+ar Roads.a11tldla Fenntrs fI11J6R tt�. <br /> PLEASE HE ACaMATE rr COMPLETE <br /> 1 1 <br /> ' KWTHCD re]SdC / "rs-&;PY FLUID <br /> i WATER LEVEL d1 YIELDOCOMPLETED WELL <br /> 17FFTH OF STATIC <br /> WATER LEVEL (Ft.) &DATE MEASURED <br /> 1 1 <br /> E37111tATE13 YIELD' (QPM)d T99T TYPE <br />' TOTAL DEPTH OF BORING (Feet) TEST LENS'ni *Imj TOTAL DRAWDOWN (FL) <br /> TOTAL DEFM OF COMPLETED WLLL— --(Feet) 'MAY Rat k rapramwave of a gvcu4 Iltrrv—y-ld <br /> ntFTK CASINC(S) 09MANNULAR MATERIAL <br />' FROM SURFACE $ � TYPE ✓ FROM SURFACE Tvpg <br /> DM MATERIALI INMRNAL GAU(3U SLOT SIZE CE 9Fs1 <br /> Qnchoo GFIA13E DME7ER OR WALL IF ANY h1ENT EN FILL T~ILTER PACK <br /> Ft ea Ft Wdle>V TWGKNES3 Eedoeey Ft, to Ft 1 <br /> (TYPEISIZk"} <br /> 1 1 1 <br /> 1 f I <br /> I <br /> 1 1 <br /> 1 I <br /> 1 1 t <br /> I 1A FIA- <br /> 1 1 <br /> ATTACHMENTS {4} CERTIFICATION STATEMENT <br /> o Log I,the underalgned,certify that ff"report is complete and accurate to the beat of my knowledge and bet(ef <br /> — Waw CoIuwaBae LMoram NAME ^ a-&AAe r- <br />' OA CrZItFOlbtll�tt)tTYPED OR I'gltflEp) ~ ••• -••• •� � •�• <br /> .._ 8aop11ysicM LaQ{e,) � �� <br /> — SalWater Chem"Anaftma + I7ilf SLRTE IIP <br /> ower <br /> ATTACH AoDnToriAL IWORAdAnM rF M EA78T$ nttl7E RE�nF$ A DA 96t n C37 FJCEHSE Ia1M6LR <br /> DVM t130ftV Tao IF ADDITIONAL SPACE IS NEEDED, GSEET-uvVt3Y NUmeEFwD FOAM a <br /> 1 r� <br />