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`The free Adobe(leader may be used to view and complete this form-However,software must be purchased to oomplete;save,and reuse a saved form.' <br /> File Original with DWR State of California ' 'DWR Use Onl'-Do Nct Ffll In- <br /> Page 9 of �� Myrell Completion Report <br /> I Refer toInswcdonPeritNefStats We 11 Number/Site Number <br /> Owner's Well Number MW-12. Ido, 0958'144 ` <br /> N W <br /> Date Work Began Date Work EndedLatitude Lon nude <br /> Local Permit Agency OA -q,-I n C',r,..rtf.1-�.rr rt..L SAe.�lfii[[ c.�wnA <br /> Permit Number 39 Permit Date ' 1 APNITRS/Ocher <br /> Geolo �cLo. K 1Nall:Owner <br /> Orientation OVerflcal 0Horizontal OAngla Specify Nams } <br /> Drilling method k Drilling Hurd C y I <br /> Depth from Surface DascriplEpn Mallin Address 3OO Yalcia tJelsat I ,L�,a7iDt 1�'L <br /> Feet "'tp -`FeetQesdrlbaniaterlel minalze calor,etc.'. . Ci +� stato—C&-z' .9. _ <br /> 4 Well)oaation.: <br /> Address 9b2�EtinQ fZco�l <br /> City 90QQCounty ,Sat <br /> Latitude yJ .N Longitude' _, <br /> Dep. Nin. „ SW0. '.1320" Min- (See. <br /> b Datum Deoimal Lit,' Decimal Cong. 13b <br /> APN Book -Parcel <br /> Township Range - Saetion g <br /> toCalt10, :5lcetch Aetiv.' k <br /> 1 <br /> v 3kekhrnuwt]eiiaini"iland'eperradnls "led. O NBvvWBil F <br /> wNorth .0 Mtidifiication/Repair ' <br /> O Deepen I; <br /> '- O Other <br /> Destroy <br /> It npsrnbs rvocedrresa�d ennradaaa <br /> `Platined Uses. <br /> O Water s i <br /> ©Damestic tic []Public � <br /> p <br /> _ r' �.-. - -- � � ❑IrBgation•❑Jndustrlal <br /> 3�j{-� = O Cathodic Protection ) <br /> - O Dewatering <br /> O Heat Exchange ' <br /> ' Olnjecilon <br /> O Monitoring ; <br /> 3�4 o -42O Remedlatton i <br /> _ Road 'S''�1r1'W 1� O 5pargirig I <br /> P South O Test WeQ a <br /> - - Rusvate atlem6e nxaneparaal homroade,anl�,�,renoas. O'Vapor Extraction <br /> dvars.etc.and aeechamap.theedmlWOPapalrnaeesauy. O Other <br /> ' Pka�e he eeeur.ta•nd con Mfs. - <br /> iter Level°and-Yl6ld:of G6 Acted Well: <br /> Depth to first water (Feet below surface) <br /> Depth to 5taua <br /> Water Level -- (Feet) Date Measured <br /> Total Depth of Boring Feet vi. 1../ Estimated Yield* (GPM) Test Type <br /> :Total Depth of Completed Well Feet l Test Length (Hours)Tctal Drawdown .. (Feet) e <br /> Way not be reprasenhative of a Wall's long term yield. I <br /> :.7 Casings'.:: :. .., .:..,. AnnurlarMatefial ' .. <br /> Depth from ',Borehole Typo Matarlal Wall Outside at Screen Slot Size Vapth from <br /> Surface Dlametef Thickness Dlameter II Typa tFAny Surface Fill 1305CAption <br /> Feet m Feet tnche5 Inchos Inches i Inches Feat to Feet <br /> . .A#taahmeltYti: �., ' ... ;, ' . CertiflcetionStateitte <br /> Oeulugic Log I,the undersigned,cerlify that this report is complete and accurate to the best of my knowledge and belief <br /> ©Well Construction Diagram„ Name t <br /> person,flan orcorporelioli - <br /> ❑Geophysical Log(s) 3632 Omec Circle Rancho Corcloya_ C� _ 95742 i <br /> ❑Solt Water Chemical Analyses s csly stare zip <br /> ❑Ocher Signed 08/14/12 938120 ! <br /> Allacneadivanalrrdamaae Ifue>data. asy can aterwe contractor Date Signed C-57 License Number <br /> SWR IBB REV.=00 -- ,. IF APDirtONAL spA.CE IS NEEDED,USE;NEXT CONSECUTIVELY N MBERED FORM <br /> I <br />