Laserfiche WebLink
STATE OF CALIFORNIA DINE11 E N I <br /> Y — D N T FILL I <br /> DUPLICATE •WELL COMPLETION REPOR 1 1 1 1 1 1 <br /> Driller'S COPY STATE WELL NO.I STATION N0. <br /> ryl Refer m Instry cn on Pamphlet �❑ ❑ <br /> Page—of—N #& — -.. •:—� No. 578172 <br /> Owner's WgII No. LATITUDE LONGITUDE <br /> 7f-9f End,d 7 26.9! <br /> Daae Work Began J q ) GU <br /> Local Permit Agency 6anN / <br /> Permit Permit Date WELL OWNER <br /> GEOLOGIC LOC ,n u�G <br /> ORIENTATION (�) —VERTICAL —HORIZONTAL —ANGLE _(SPECIFY) Name Addr, <br /> DEPTH TO FIRST WATER (FL) BELOW SURFACE .Mailing �. VX V <br /> DEPTH FROM DESCRIPTION <br /> SURFACE CITY WELL LOCATION <br /> Ft. to Ft. Describe material,grasp Sim,color,etc. <br /> Addre51 e <br /> City <br /> County �� CTOR fiy ✓I <br /> APN Book Page Parcel <br /> Township Range Section <br /> ` NORTH Longitude WEST <br /> Latitude DEG. IN. SEC. <br /> CEG, MIN. SEC. TIVITY (�) <br /> LOCATION SKETCH <br /> NORTH NEW WELL <br /> MODIFICATION/REPAIR <br /> Deepen <br /> Oman(Specity) <br /> DESTROY(Describe <br /> Procedures and Material. <br /> Under"GEOLOGICLOG') <br /> r PLAN D USE(S) <br /> m 1 <br /> gNj UJ MONIT)ORING <br /> 3 <br /> ATER SUPPsLY <br /> D....ti- <br /> Public <br /> Irrigation <br /> • <br /> Indushial <br /> TEST WELL"" <br /> CATHODIC PROTEC- <br /> SOUTH TION <br /> mchill.simOst a or Describe Distance of Well from Landmarks <br /> OTHER(Specity) <br /> such as Road..eullEefli etc. <br /> PLEASE BE ACCURATE <br /> & CTE b COMPLPL ETE. <br /> DRILLING �/irYV _FLUID <br /> METHOD ���/��,`"`'� <br /> WATER LEVEL & YIELD OF COMPLETED WELL <br /> DEPTH OF STATIC <br /> WATER LEVEL (Ft.) IS DATE MEASURED <br /> ESTIMATED YIELD' (GPM) 8, TEST TYPE <br /> TOTAL DEPTH OF BORING (Feet) TEST LENGTH— (Hrs.) TOTAL DRAWDOWN (FL) <br /> TOTAL DEPTH OF COMPLETED WELL (Fee[) <br /> *May not be representative of a Well's long-term yield. <br /> ANNULAR MATERIAL <br /> CASING(S) DEPTH <br /> DEPTH BORE- FROM SURFACE TYPE <br /> FROM SURFACE HOLE TYPE —' INTERNAL GAUGE SLOT SIZE CE- BEN- FILTER PACK <br /> DIA. w c _ MATERIAL/ DIAMETER OR WALL IF ANY MENT TONITE FILL (TYPE/SIZE) <br /> z. c GRADE THICKNESS (Inches) Ft. to Ft. <br /> (Inches) an <br /> y So d (Inch..) (—) (—) (�) <br /> Ft. to Ft. _ <br /> TEMENT <br /> ACHMENTS (!) CERTIFICATION STA /ry, <br /> I,the undef9jgned ertify <br /> G/is repo �mPlet and accurate to the Est of knowledge and belief. <br /> Geologic Log r � <br /> . _ Well Construction Diagram NAME(PERSON�, FiIRM, OR CORPO�MjTIO (TYP OR PR�INTTEEDD)�1 ��� <br /> _ <br /> Geophysical Logs) /� p.Jl,/ ZL'J�/ ! �O/t//��Q C�Y`T-•1•� C' — <br /> _ <br /> Soil/Water Chemical Analyse. J(•J -/((//nn CITY STATE / ZIP <br /> ADDRESS <br /> _ Other l O —rfLYl lY f�/ <br /> Signed DATES ME' C-57 LICENSE NUMBEF <br /> ATTACH ADDITIONAL INFORMATION. IF IT EXISTS. WELL GRILLER AUT ED REPR NTATI <br /> DWR 188 REV.7-90 IF ADDITIONAL SPACE IS NEEDED, USE NEXT CO SECUTIVELY NUMBERED FORM <br />