Laserfiche WebLink
'The free Adobe Ruler may be used to vlew and complete this form. However„software must he purchased to complete,save;ertd reuse a saved form. <br /> Pile Original with DWR "'” Slate of Cali€dmta .'DWR lists Onl =Ro Not Fll!in <br /> Page_[ Of �_ Well Completion Report �. <br /> Rererlo fnsrrerr�nrar State Wei NumberlSlte Number <br /> Owners Welt Number i�/i W� _ � No:e015810 84Q7 � N W , <br /> Date Work Began 742 to/ Dato Work Ended /1<2 Latitude Lo f[i de <br /> Local PiarmllAgency _ Ci' <br /> Permit Number Permit Date ?2 APNfrR5f0lner <br /> Geolo is t o <br /> Well_oqMzr:.. . <br /> Orientation evert5cal 0Hortiontal OAngle speclry L Name <br /> AV <br /> Ddltng Method 6.W Drilling Fluid <br /> Dopar frortl surface Description s - Mailing Address <br /> Eeet". I F.eef Describe metedal' aln rize e" Ci <br /> corer to Sca/�..,1.� �--- State_ i <br /> :1 ,well=Lgoetiari <br /> Address <br /> oily CDtirity n . or r tuff <br /> I alitude _',"N Longitude, _� <br /> Min. Sep. ',Doty. Min. •Sea <br /> �a ! Datumhl,ADg3 Decimal Lat:31251 Decimal Long: <br /> s <br /> APN Book -Page ; parcel : <br /> ! Townshi 2S Ftari aF SeclEon=�9."' <br /> Locatit n SkWfi _ =Activit': <br /> li ., '- Skeldirraisfbearawnh"haridsffarfnnn k"nled- 0 NBW WB[I <br /> North <br /> • ,i .. O ModificationlRepair <br /> O Deepen <br /> O Other <br /> 1 Destroy <br /> - - eeoerl0a y,ecadensa�,m,oire6 <br /> > k `Was4i rFjarittl2E°uses; <br /> O Water Supply <br /> M\i4 S []Domestic 0 Public <br /> ©irrigalion r-lIndustriar <br /> O Cathodic Protection <br /> O Dewatering <br /> O Heat Exchange <br /> w O Injection <br /> y�yn �,W.,iY�1L� �,/Y� O Monitoring i <br /> B,rnd j tune .35 <br /> d86,H M O Remediation ' <br /> O 5parging <br /> �rordat-Raaf i5 I U§pv0� M1Af-gj O Test Well <br /> F. Sac <br /> O Vapor Extraction.:. <br /> ..- WIa4sla aaaaonOs aataroa Mwes emn,oeas,Leirtlings,yentas. i <br /> bean.eta and atteshe msp.usnaamea,�I wvarrr,a� Q Other <br /> ' Aher�Le fleeurab a�emn felts � i <br /> Y _a it;Lgirelatid Yield of Coriipfeited'Wgll <br /> f <br /> Depth to first water ' (Feet below surface) <br /> Depth to Static <br /> Water Level (Feet) Date Measured <br /> Total Depth of Boring ":rl Feet i; s Estimated Yield (GPM) Test Type <br /> .Total Depth 4f Completed Well Feet Test Length :' (Hours)Total Drawdown (Feet) <br /> *May not be representative of a well's long term yleid. 1 <br /> Casln s Annular:Nia>etisl t <br /> Dopth from Borehole 7 e Material Wall C utalde Screen Slot Size Depth from <br /> urfa <br /> Sce 'Diameter yA Thickness Diameter ' kType VAny r Surface Fill Dassripgon <br /> Feet In Feet Inches Inches (inches). Inches Feat to Feet ; <br /> Pr <br /> AttachineHts_ -;CirtificaEioit;Statetnent;,':.. <br /> ❑Geologic Log rNa <br /> undersigned,certify that this report Is compiete and accurate to the hest of my knowledge and belief <br /> ❑Well Construction Diagram Cascade Dr111ingr L.P, _ <br /> r Peraan,Firm w CarparaWn k <br /> ❑ <br /> Geophysical Logic 3632 Omec Circle Rancho Cordova Cg :95742 l <br /> ©SoilANalerChem€cal Analyses "' Add cty �a� zrP <br /> ' ©Other d 08/14/12 938110 <br /> A"additionannfoanaU ri<ayrsis. "71.krmsed ler ell ctor Date Si ned C-57 license Number <br /> DWR lee REIT.imm - .i IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORA <br /> ! <br /> t <br /> ! <br />