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V <br /> 'The free Adobe Reader maybe used to view and complele this form. However,Seftware must be purchased to complete,save,and reuse a saved form- <br /> File Original with DWR State of Calitornia OWR.Use Orgy—bo N04F111 Irl. <br /> Y ` Weil Completioin Report` <br /> Page I pf Rofartp lnshtMtim Pamphret State Well NurnberfShe Number <br /> Owners Well Number MW-15 No.e015B114 <br /> Date Work sagan Date Work Ended_-16 25/7 M * L Latitude—�� Longitude W <br /> Local Permit Agenz-I f +•^ �Q4 x1•r l~rt.x Tr o los Nr, A-AA <br /> Permit Number. (o r7�i j L Permit to APNrrFtsrotfter <br /> Well•Owner <br /> Orientation. *Vertical O Horizontal OAngle Specify Narne Iman AVi <br /> DTIU]ng MethadDrilling Fluid <br /> befith from Surface p'escdpllon Mai]in Address <br /> FeEt lo.: -Feet Desciibe rnatrarjal,grain size.color.etc OI State�eA li `�'�� <br /> ,.re_LLtoc ' Well L.ocadori <br /> Address_1072-Fnat}cr e+��.r1 <br /> City Rap"V% CountyrA 11Dar,!uA <br /> Latitude .N I Ongilude �5.�s � <br /> - pen. Min. Sea-..- 'Dee. Ngo. ,Sa <br /> ei <br /> Datum Decimal Lat:�Decimal tdng.12� <br /> APN Book, 2-6 1 Page G Parcel <br /> Township 25 :Rari a �� SecAon <br /> ? s L:ocafi6rl,Sketc33': ,..' Activit <br /> sketch must ba diai*K6 tla.rd afler.fam is pflnl6d. .,. O Neva Well <br /> North - Q.Modigcatlon/Rapair <br /> O Deepen <br /> O Other <br /> .- <br /> 16 Destroy <br /> oe:mm <br /> mese,eG' <br /> .. aer'OEOLaGIC lee• <br /> W <br /> " i <br /> �'ir`R. O Water Supply <br /> [:i Domestic nPublic <br /> ❑Irrigation ❑Industdal <br /> O Cathodic Protection <br /> t O Dewatering <br /> 0 Heat Exchange <br /> 0Injection ' <br /> - Truck Wash .O Monitoring <br /> T �cwe;s ZJW�5 O Remedlation <br /> j <br /> oee Ti�;s.22 'W of WA5 rst Wl <br /> outh <br /> litisrrale erefssa6e asaira orwca ham peas.Ge�ldfngs.fonws. Q Vapor Extraction <br /> w.n er..we�aa .p.ureadaeranapapesnaeossey. O: Other'i rn..he,ae,.e.ma mm. , <br /> Writer Level and Yield of-Com• Ieted Well <br /> fDepth to first water (Feet below surface) i <br /> Depth to Static <br /> Water Level (Feet) Data Measured:! . <br /> Total Depth of Boring Feet Estimated Yield• (GPM) Test Type <br /> I ! Test Length (Hours)Total Drawdown (Feet) <br /> Total Depth of Campieled Well "' ' Feet *May not ba representative of awell's long termetd- <br /> Casio S. s: :r _m:;4nnular Material <br /> Depth from ` .13orehole 'Type Malarial Walt Uutslde screen Slut size Depth from <br /> �. Surface 'Dlainate►, ,' YP al -rhickness Diameter Type If Any Surface Fill Description <br /> Feet to Feet ,InrKes) onches Inches Inches Feet .(a Feet <br /> IL i <br /> i 1 <br /> s <br /> -Attataimenta : .'... Certificatioti`S4atemenf .. " : <br /> ❑Geoltigic Log '''' I,the undersigned,certify that this report is complete and accurate to the best of my knowledge and belief <br /> ©Well Construction Diagram.- Name <br /> i Geaph ical Lo s Peraon,RrmorCorporelton i <br /> Ys Log(s) 3632 c Circle' Rancho Cordova SCA 95742 <br /> g ❑SollMtater Chemical Analyses city state Zip <br /> ❑Other signed OR/14/12 . - <br /> AaacheddNanellnfomsaBan 9Itexists C-51 Maofisodwal.,Macwlr for -Date Signed C,5T Licume Number <br /> DwR 188 REV.11200 IFADOIT10NAt.SPACE ISNEEDEp,USFNFXr CONSECLMVELYNUM13ERED FORM <br />