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ORIGINAL STATE OF CALIFORNIA DWR USE ONLY — 00 N 0 <br /> r F I <br /> File with DWR • 'WELL COMPLETION REPOR-0 <br /> Page 04 Refer to Instruction Pamphlet STATE WELL N0./STATION NO. <br /> Owner's Well No. i� w 3 No. 413675 FE ❑O C <br /> Date Work Began , Ended LATITUDE LONGITUDE <br /> Local Permit Agency FT, I I I I I I I I I I <br /> Permit No. 0 Permit Date a A / / <br /> GEOLOGICLOG WELL OWNER <br /> ORIENTATION (Z::) X VERTICAL _HORIZONTAL _ANGLE _(SPECIFY) Name. Unocal Corporation <br /> DEPTH TO FIRST WATER (FL) BELOW SURFACE ;Mailing Address P• O. BOX 5155 <br /> DSU <br /> SURFEPTIA ACE DESCRIPTION SanRamonCA 94583 <br /> — <br /> Ft. to Ft. Describe material,grain size,color,calor,ec. - WELL L O C A T I O N STATE ZIP <br /> Addressr. <br /> aamaz <br /> Seel Attached Borinir Los city, <br /> CountySQn L?oageiiA7 X <br /> APN Book Page Parcel <br /> or <br /> Township T�NRange 76 Section <br /> on <br /> LStiti de NORTH Longitude I I WEST <br /> DEG. MIN. SEC. DEG. MIN. SEC. <br /> LOCATION SKETCH ACTIVITY (!)— <br /> NORTH _X NEW WELL <br /> MODIFICATION/REPAIR <br /> _Carlos. <br /> See Attached Site Plan _Other(Sped ) <br /> DESTROY(Describe <br /> P ocad..aand Material <br /> Under"GEOLOG/CLOG <br /> y m PLANNED USE(S) <br /> m to ( ) <br /> �+ w MONITORING <br /> WATER SUPPLY <br /> Domestic <br /> Public <br /> Irrigation <br /> _ Industrial <br /> "TEST WELL" <br /> SOUTH TION�DIC PROTEC <br /> Illustrate or Describe Distance of Well from Landmarks — OTHER(Specify) <br /> such as Roads,Badd(ngs,Fencer,Rivers,etc. <br /> PLEASE BE ACCURATE G COMPLETE. <br /> DRILLING <br /> METHOD HnIInW StPrrl ATIgPT FLUID NO <br /> WATER LEVEL & YIELD OF COMPLETED WELL — <br /> DEPTH OF STATIC I Jr <br /> WATER LEVEL (Ft.) & DATE MEASURED !!T/ / 9a <br /> ESTIMATED YIELD' (GPM) H TEST TYPE a <br /> TOTAL DEPTH OF BORING (Feet) TEST LENGTH_ (Hrs.) TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL (Feet) a May not be representative of a well i/oag-term yield. <br /> DEPTHCASI NG(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE BORE- <br /> HOLE TYPE _I FROM SURFACE TYPE <br /> DIA. w c i MATERIAL/ INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> (Inches) < s oG GRADE DIAMETER OR WALL IF ANY MENTI TONITE FILL FILTER PACK <br /> Ft. to Ft. (Inches) THICKNESS Onchee) Ft. to Ft. (TYPE/SIZE) <br /> Vim ¢ <br /> i <br /> ATTACHMENTS (L) - CERTIFICATION STATEMENT <br /> X I,the undersigned, artily tha epos'is complete and accurate to the beat of my knowledge and belief. <br /> Geologic Log <br /> Well Construction Diagram NAME <br /> (PERSON. FIRM, OR C RMUTION (TYPED OR PRINT D) <br /> Geophysical Log(s) <br /> Soil/Water Chemical Analyses J !7/x•5/ <br /> Site Plan & AD Cm STATE TIP <br /> Other 7�a9 <br /> ocatlon ag si a <br /> ATTACH ADDITIONAL INFORMATION, IF IT /STS. �11MLIIKIRNIVED RE NTATI DATE $IG D GS] LICENSE NUM ER <br /> OWN ISS REV.7-91) IF ADDITIONAL SPACE IS NEEDED, USE NEkf CONSECU IVELY NUMBERED FORM <br />