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V <br /> `The free Adobe Reader may be iced to view and complete this form. However•software must be purchased to complete,save,and reuse a saved form. <br /> File Original with DWR " 8'ate of California . DWR Use pill =Dd Nal Fitl In . <br /> .---�= Well Completion Report <br /> Page of-. ' Refer tolns6ucucnPamPnfar- State Well NumberlSiteNumber <br /> Owner's Well Number — No. e0158792 c N W <br /> Date Work BeganO1(2U' 12 Date Work Ended O /1 L/1`1 = Latitude Lon Itude <br /> Local Permit Agenc <br /> Permit Number Permit bats y APWM310tlter <br /> C@d10 iC.)t o Well Owplr; <br /> Orientation *Vertical OHortzontal, OAngle Spectiy Name <br /> Drilling Method 'Draling FluidI <br /> Mallin Address <br /> pepth from Surface peseriptlPn = ,�•�a�ns94 <br /> .••Feet '.'ru..':Feet "'Descri6e rine l' rem size cdfor,etc Cit Stale SsLtCf 1AChAi 6 ex" nu � <br /> ;Vlf�ll:L`gcatibli - <br /> 3 + Address_f62Z GmyAnca._ R,,qr�' <br /> -- - - - - City.Ri+,nn_ _ -- - County;r7an.jrncrf fi(\ . <br /> ' Latitude ' h1 Eongituk�e}�L• '_ <br /> q Dap. Mir. sop.. '•Dep. Nin. <br /> k <br /> DatumW,93 Decimal Lal< _.DecimaLLeng:J203_ <br /> APN Book'Pago �-0 Parcel '92 <br /> _ + i Townshi Ran a Section <br /> SketeikinuL <br /> 4itieSdabori Sketcij ".nio <br /> ,;`N..A..ti.::WAec <br /> l# <br /> l <br /> North <br /> iv <br /> lt <br /> palr0 Mdification)Re <br /> Deepen <br /> O Other <br /> Desroy <br /> - w1,r'. Lo3,ra'Janr rr.letl�s <br /> eaaer•aea�vare lDe' _ <br /> _ - Y t :dtesmQpfi �tW��J " -:,Planned:Uses:: t <br /> 0 Water Supply <br /> ❑Domestic []Public a <br /> d l r7cli ❑1algation ❑Industrial ' <br /> A- <br /> 0 Cathodic Protection <br /> - Ll 0 Dewalering <br /> ' - 0Heat Exchange- <br /> .: f a���•0 0 Injection <br /> L� i It � n�fr.Set rias O Manitodng <br /> �_- , • Mw_3 0 Romedlatlon <br /> �- rtld Cnt+u is 443�'N�sF MW-1.3 O Sparging <br /> � ttiSSouth"'W sFM1Al-43 O Test Wen <br /> o�ear«aesoaaa�ionoaoi narroa naas hula gs•re�ms. O <br /> Vapor Extraction <br /> g' duan,aim a N Wlacn emaP.flee aeeifionai pope r nares.y. 0 Other. <br /> Phe+.Ea eccarale�Mcem lel. <br /> atel`Lev&Land Yield of:Cgrnpleted VUeI! "`'" i. L <br /> r. Depth to first water (Feet below surface) t <br /> Depth to Static <br /> Water Level (Feet).,pate Measured 4 <br /> Total Depth of Bering Feet Estimated Yield` (GPM) Test Type r <br /> Total Depth dl'Completed Well r Feet i Test Length (Hours)Total Drawdown (Feet) <br /> a *May not be re resentative of a well's long term vield. V4 <br /> Casin s . <br /> Annular Allaterial <br /> Depth from ' .Borehole . T MataWali Outside Screen Slot size Depth From <br /> Surface .. DEatneler yl� ilat Th[ckness Diameter `.Type if Any - Surface Fill Description <br /> Feel m Feet (Inches)' Inches Inches Inches Feet to Feet <br /> k I <br /> Y - <br /> ©Geologic Log 1,the undersigned.certify that this report Is complete and accurate to the best of my knowledge,and belief <br /> Well Construction Diagram - -« - Name .Cascade Drilling. L-P. - - <br /> t. Parson,firm m corpofaton - <br /> ❑Gel(Water Cheophysical mical <br /> •• QjLgg ?anphQ Cnydnya �'� 957[17 <br /> ❑SokUWater Chemical Analyses a cttr smm - zip -'"""- <br /> I ❑Other Signed r 1 . , 08/19/12 938110 <br /> Atfadi add8lonni infonnatlon Nik axi5la. <br /> G5 nsaawaler el trot r Date Signed C-57 Llcertse Number <br /> DWR 188 REV.7120a8 IF ADDITIONAL SPACE ISNn!)W.USEWXTCONSECUTIVELYMJMBFRFDFORM "' <br />