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se a <br /> saved <br /> 'The free Adobe Reader may be used to view and completedl, However,software must be purchased to complete,sa d reuDWR Use Onl�Do Not pit In <br /> File Original with DWR I <br /> Stale of California <br /> Well Completion Report <br /> Page I_ of Refer to lnstmction PamphletN rTT�umberlSile <br /> A, „ ,_ "Z IBJ—, <br /> Owner's Well Number No. e070704 LaIrmue Lon etude <br /> Date Work Began P 2 n - ¢ Date Work Ended C iil Ib <br /> Local Permit Agency 1 otr4l In Le ENv Her r4 gpN/TRSIOther <br /> UC i a, l 7 3 Permit Date O z 2�j lE A <br /> Permit Number W811 Owner <br /> Geoloidic Lo <br /> Pro <br /> orientation *Vertical O Horizontal OAngle Specify Name 7nr1 U c ` <br /> Drilling Method Drilling Fluid r'aji;rg Address <br /> crC <br /> Depth from Surface <br /> Description ,Describe material, ram size,color,etc Cil �4 r 5;16'1 State i <br /> Feet m Feet Well Location <br /> Address y-S kj 8 <br /> City <br /> _County <br /> LatitudeN Longitude __--Rn—�N <br /> oep. min. sec. Deg. Mln. sec. <br /> Datum Decimal Lat. Decimal Long. <br /> APN Book Page Parcel <br /> Townshi Ran a Section <br /> Location Sketch Activit <br /> Sketch must be drawn b'hand after form is noted` QNew Well <br /> North Q Modification/Repair <br /> O Deepen <br /> O Other <br /> ®Destroy <br /> oncase aem <br /> OLoo1c m.mnei. <br /> uNa,'GELOGiC LOG' <br /> Planned Uses <br /> Q Water Supply <br /> []Domestic []Public <br /> 3 w <br /> ❑Irrigation ❑Industrial <br /> Q Cathodic Protection <br /> Q Dewatering <br /> Q Heat Exchange <br /> Q Injection <br /> Q Monitoring <br /> Q Remediation <br /> r1 Q Sparging <br /> Q Test Well <br /> South Q <br /> IVapor Extractim <br /> inseam c,aesit msma.m..Nwan�oae..ewsw:. <br /> rw.R.em.and arra.a aI n an.uc..aa�nnn.ronpa O Other <br /> Fla..e ns.ca.+m.na can LIs. <br /> ater Level and Yieid of Com 3leted Well <br /> Sr Depth to first water (Feel below surface) <br /> On U � Depth to Static <br /> Water Level (Feet) Date Measured <br /> Total Depth of Boring Z 9 <br /> Feet Estimated Yield' (GPM) Test Type <br /> • Test Length (Hours) Total Drawdown_(FaetI <br /> Total Depth of Completed Well -3 Feet `Me not be re resenlative of a well's Ion term ield. <br /> Casio Is Annular Material <br /> Depth from Borehole Wall Outside Screen Slot Size Depth from Fill Description <br /> P Type Material Thickness Diameter Type if Any Surface <br /> Surface Diameter Inches Inches 'inehes Feet to Fee, <br /> Feet to Feel Inches L <br /> ID v� <br /> r: tI <br /> Attachments Certification Statement <br /> -Geologic Log I,the undersl certl'�y t a1 i reRoV yLomplete acrd accur�t�to)1 est of my knowledge and belief <br /> Name �ST/lM�(Gl�!-7 //KK- /Jl/�i LL7 ' <br /> Well Construction Diagram r-Pers ,Firm DrC: renin �,,,���� <br /> Geophysical Log(s) _��9-. Iv�7 J✓r•" l� I�A♦ ity . t -) n SIA_ - zQ N <br /> ❑SoillWaler Chemical Analyses A tlress � � r � :"�- �,, I c.1-1 <br /> Other Signed +-I N <br /> S �f Mn,�_ II T LIcense farn rr ao Date Signed C-57 License Number <br /> IAa cn aar IL l n Iia ials <br /> MR 188 REV.112006 IF ADDITIONAL SPACE IS EEDED.USE NEXT CONSECUTIVELY NUMBERED FORM <br />