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4 <br /> 'The freeAdebe Reader maybe used to view and complete this farm.However,eottware mast be purchased to eDmpletd.save.and rouse a saved form. <br /> File Original with DWR Slate of CalifbWa DW_R use Ont'--.Do Not F1111h <br /> Pagef 1 Well Completloh Report-Owner's <br /> eport <br /> Rahn to InsfrycNpra Apmphlei <br /> t --a State Well Number/Site NumSer <br /> Owner s Well Number No. e0'158909 N W <br /> Date Wali Began' Date Work Ended �1 /23f� Latitude 1-on'tude <br /> Local Permit Agen,y <br /> Permit Number Permit Date�/1,{x/42 _ APNrrRStOther <br />!, , - '•�_Geolo ic1;o .; - : :. •: ., . . y.. ',Well.Qwner;'.;: <br /> Orientation OVartical 0Harizontal OAngle v specify Name 01,jrAP16AV <br /> Driifmg Method Wiling Fluid aAddress. <br /> 1 T� <br /> 'tlepth'fronm surface : bescriptiori M FSrr1 <br /> Mailing Address. �YtUa l a; 2 <br /> '.Feet Io ,.'FAet -hescrlba niateifal, rain size.Cafor:etc. '- i Cit SQA-�rrEns -- _ Stater-&—z", <br /> O ;trVeli.l ocatlan:"'.•' <br /> Address'V10` •:�ran�etr�: Iin cl <br /> City Rlpcha t-Vnty_Saa or� --A <br /> Latitude .:3� �.�� N Langttuda, <br /> y Dm Mer. Sec ..-. ... . E". Min. Sac. <br /> - <br /> Datum�$�Becfmal La -Decimal Lmg.-121.1.32 <br /> c' APN Bock Page 1121) 'Parcel 12`..:. <br /> s. <br /> Township Rani e A 'Secllon 9 9'--- <br /> I <br /> Locoteliri Sketch : petivl <br /> ., Sfcelchmu€{tie`nreiunby <br /> 'Eraridaftefaumis'iinleai. O 116IvWBII <br /> North ().Modl@catfonlRepair <br /> Dee <br /> .. . . O pen <br /> O Other <br /> — <br /> Destroy Destroy <br /> MW-1D <br /> aeacrha unae'n enaeaeh <br /> ,. w+der'GFOLOOIC LOS' <br /> ?° :Planned USOS <br /> �S O Water Supply <br /> c4/C tw ©Domestic [[Public <br /> : a ©Irrigation []Industrial <br /> Cathodic Protraction <br /> i, i O Dewatering <br /> O Heat Exchange <br /> O Injection <br /> ' O Monitoring <br /> Bft�y I-Cw�is 3�jq'N at WlW_j0 O Remediation <br /> iytoitRcart:s�j�F'Wd MW 10.. O Spar>3ing <br /> South O Test Well <br /> � mus¢araa6aam3edEelenoa orYrtl Yom meds,hslVdlr�s,rarcea. <br /> O Vapor Extraction <br /> 3'. Rvan:.ie.end enecho mop.Use addaoael popar7ner -V- Q Other <br /> rime sea"mw.wavmprte, <br /> atet Level.alid Yieid.QiPOilfi leted'Well <br /> I <br /> # : 7 'Depth to fust water (Feet below surface) <br /> Depth to Static <br /> Water level., (Feet) DateMeasured <br /> Total Depth of Boring Feel k • Estimated Yield* (GPM) Test Type <br /> Total Depth of Completed WeflFoot k r Test Length (Hours)Tatar Drawdown (Feet) <br /> *May not be re reseritative of a well's long term yleld. <br /> AnnularMattsrlat ' <br /> Depth from torehate 7-.- Wait Outside Screen Wot size Doplhm <br /> Surface Dlarrteter': Thickness Diameter fro - - - - <br /> yge Matektal Type If Any Surface 'Fill Description <br /> ,." <br /> Feet to Feet Inches inches inches 1'. inches Feet to Feet <br /> Attachments :.. CErtifjcatlon Stateirieitf:; <br /> ❑Geologic Log I,the undersigned,certify that this report is complete and accurate to the best of my knoxrledge and belief <br /> ❑Well CDnstructlon Diagram ' Name <br /> Person,Firm a corporaum . <br /> Cl Geophysical IAg(s) 32 Qv Ci:'cl Rancho Cordgya- CA - 95742 <br /> ❑Soil/Water Chemioal Analyses coy Blaie Tp <br /> ❑Other Sighed Y— 08/14/12 -._938110 <br /> Mach add.fiDnal Kmalr i Q-5T M a r 0 e.0 Vator e contrw Dale Signed C-57 License Number <br /> DWR 188 REV-112008 IF AODITICNAL SPACE IS NEEDED,USE NE?(r CONSEcUrIVELY NUMSEREP FORM <br /> I <br />