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i <br /> • I <br /> "The fine Adobe Reader maybe used to view and cmplete this Corm.However,software must be purchased to complete,saw,and reuse a saved form. r <br /> File Original with DWR ""` State of Calildf.hia �--DWR,Use On -�Do Not I'll In' -" <br /> Page 9 r f Well Completion Report - <br /> f <br /> ROW to1nMwdknftrm rki Stale Well Number/Site Number <br /> Owner's Well Number No, at115 it l7. , i I 'i-�—ice N� w <br /> Date Work began Date Work Ended LaUIDde Lon nude <br /> Local Permit Agency [' I <br /> Permit Number . Permit Dae 9 2 APNlrRSAXher <br /> Geo10 is t 6" <br /> -Weli;oviner <br /> Orterdatlon •Vertical 0Horizontal OAngle .-specify : Name <br /> Drilling Method Drilling Fluid 4 I I R _t 5, <br /> Maili Address .a hear v. <br /> pepih from 5uriace _i)escriptioh. '' I '" <br /> Descdbe rrTaterlal, rain size colo:etc. _ , Cit [,:etris ...__3tatel.-I 3GL3,,�.�. I <br /> Well'L1�cation <br /> 2 1Address <br /> City County <br /> :• , 33 009, 144— <br /> Latitude 4 N Lon nude i <br /> -- - s <br /> . ! Dee. Mm. So.' ' :�.� Dee. r1�n. ",sec. <br /> _ W. s Datum Decimal Ueit:;3E,15 T .Decimal Lang <br /> y t All Book 2,'L'Paige��} Percef <br /> Townshl ;Ran F+ "Saotion. 1 ._� <br /> : ..Loeaticio Ske4ah Activit <br /> .(Sl idustbedlawn .1.handafladfomt.ls'iiiled:': <br /> Ndrih O New Well <br /> _ f O MadificationlRepair' <br /> .O Deepen <br /> " O Other <br /> E •l ®Destroy <br /> - Dssaloe res antl mtod is- } <br /> •sirctoD <br /> .:Planned.Usi <br /> O Water Supply <br /> y ❑Domestic ❑Public <br /> —�O ❑Irrigation ❑Industrial <br /> link Aem-ill O Cathodic Protection <br /> E. . <br /> r, t 4 Dewatering <br /> O Heat Exchange <br /> c 0 Injection ` <br /> B i&Yu-_13 r <br /> 494' J A MWAB <br /> - � O Monitorfig ' <br /> O RLmedialion <br /> w63`W of N�Y�t-18 O Sparging <br /> v scum O Test Well` <br /> Q WSW.auesameaeurcaar�rtrs,ameas.euw.maraeces, OVaporExtraclion <br /> asers,otC,dnaanachasnsp,Use <br /> eaaalandpaneperIwy. O Other I <br /> - Plum baa[curalaanaranl rata <br /> atcr.Level:and YieId oKOrhil Will <br /> h Depth to first water (Feet below surface) <br /> Depth to Static ...__..... <br /> Water Level (Feet) Dato Measured r <br /> Total Depth of Boring Feet .•= Estimated Yield` (GPM).Test Type I: <br /> Total Depth of Completed Well Feet- 'Ad�r:1 Test Length (Hours)Total Drawdown (Feet) <br /> 'Ma not be re resenlative of a well's long term yield. <br /> "Annl Material <br /> Depth from Borehole Wall Oulside ei Screen Slat size .Depth from <br /> Surface Diameter Type Material Thickness Diameter A'W�ilType if Any �1 Surface ;Fill Desulptlon <br /> Feet la Feet Inches Inches Inches ,i'l Inches Feet W Feet <br /> k t <br /> # 1 <br /> _ T <br /> Attachments " ertiiication SfatBirierik <br /> ©Geologic Log I,the undersigned,certify that this report Is complete and accurate to the best of my knowledge and belief <br /> D Well Construction Diagram. Name € <br /> Person,Firm or comor on <br /> Geophysical Logs) Ranclio c_or ova CA 95742 <br /> ❑SoillWater Chemical Analyses ar` cay slate zip- <br /> ❑Other Slgnod r- 08414412 23 B 110 _ <br /> aacnearnilonar 7 ' testate. G5TLkensedWaterWelFConVeclo Date Signed C-57 License Number <br /> DWR 188 REV-112DDa IFADDMONAL SPACE 19 NEEDED,11SE NExrcoNSEcurrvaY NUMBERED FORM <br />