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'The free Adobe Reader may be used to view end complete this form. However,software must be purchased to complete,save,and reuse a saved form. <br /> File Original with DWR State of California <br /> =".iAWR llso 17111' Qo NolFGI In i=' <br /> Page of I r Well Completion Report <br /> 6 Aefar1bknavclknPam01ar State Wall NumberfSlteNumber <br /> Owner's Well Number " No. e0158102 ' N w <br /> Date Work Began Date Work Ended Q'� 92Z i afuude Longitude <br /> LoDal Permit Agoncy. <br /> Permit Number, 1,%, 1 k—Ld Permit Date -(M1? /11 APnurr�s/otner <br /> „ Geolo Ic Lo .' s <br /> Well:Owner <br /> Orientation •Vertical 0Horizontal OAngle Specify - Name <br /> Drilling Method ' t ndiling Fluid <br /> �apth:from`Surfaca DescrlpHon Mailin Address <br /> Fest: to ;'Feat De6cii6a M'aferhal--'In size color"etc d � Cif State <br /> Well.1_96tia l <br /> _ ISS:!CCfltfa'�c�C�.._�'_LcS------__.. <br /> Address _ <br /> City R,pyl County 5-,4 ,1,10A .-. <br /> Latitude _ <br /> Datum1fALfi5 DecimalLot: _�j71 Decimal Long.712j_J_j9 <br /> APN Book .,C� Page. �20 Parcel <br /> Township .1-9 - <br /> �� - <br /> - '--_.: 8fwlchmu3lbe dm�lri'hHrniil afSerioriii l's ,anted O <br /> North New Well <br /> f Q Modification/Repair <br /> yA `O Deepen <br /> 1 (:)Other <br /> ®Destroy <br /> - oesa,be pmex4res ena mllml9lS <br /> _ Mamreanr;�c o� <br /> # N <br /> a r O Water Supply ' <br /> v )]Dolnestle OPublic i <br /> m ©Irrlgation ❑Industrial <br /> rote O Dewatering <br /> Protection <br /> '1' O HeatExchanga <br /> O Injection <br /> { O Monitoring a <br /> r _ ORamediation <br /> a O Sparging <br /> SOuth O Test Well <br /> uaeua,a a.da:ma res—or Dar rmm l dA.WdMrG.rencas. - Vapor Extraction6N .@lc.andrltacl.ommp-UsneddlWWpaperl(mcammy, Qpiher <br /> Praa.am acxu Dad corn tele, <br /> + U7t6e L:evefa'rfd yleh#:of C.om"ietl d WeII :` :: <br /> Depth to first water (Foot below surface) 1 <br /> ` Depth to Static r <br /> Water Level (Feet) Date Measured <br /> Total Depth of Baring +:' Feet Estimated Yield (GPM) Test Type <br /> Test Length (Hours)Total Drawdown (Feet) <br /> Total Depth-of Completed Well Feet Way not be representative of a well's turig term 4eld. <br /> Casln ;:An"riufar.INaterlal <br /> i Depth from '„_Borehole ateila! Wall Outside Screen stotstze Depth from, <br /> Surface DleMerdt TYpa Thickness Diameter Type if Any Surface Fill DeswIptlon <br /> Feet to Feet (inches)' Inches inches Inches Feet to Feet- y <br /> r r <br /> e a <br /> 4 <br /> l 1 <br /> Certlficatlot SCaterlrtent <br /> - <br /> ❑Geologic Log I,the undersigned,certify that this report Is complete and accurate to the best of my knowledge and belief <br /> D Well Coastructlnn Diagram f - Name.Cascade_nr;11 ing. L_r_ <br /> Lo s Pe can•Film or Corparalton <br /> E3 Geophysical <br /> 9O '". 3 32 Om c Circle , ov _QA X5742 <br /> r ❑SoillNater ChemEcat Analyses 'A Q11oira1;;Zi2 <br /> - ctfy state IIP <br /> Signedr <br /> ° <br /> 13 Other 9r �l Z a IT 7 _938]_]_0_ <br /> Allach eddillonallnfom,a-inle,dsls. C-57Lrcensed afar Date Si Signed C-57 License Number <br /> DwR 188 REV.114M IF AOD1TfDNAL SPACE 1S NEEDED.USE NEXT OONSEC[JnVELY NUMBERED FORM <br />