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' ORIGINAL <br /> STATE OF CALIFORNIA PWR USF ONLY DO NOT FILL ITN <br /> File with DWR WELL COMPLETION REPORT 1_ I I I .,.,II I ._1 I I I I I <br /> ' Page j p}' i Refer to Znetrert(on Pamphlet STATE WELL NOISTATION NO <br /> Ownees Well No -1 NO e012891 <br /> WWork Began y'A( --Oy Ended "Z&-Oq LATITUDE ❑ LONGITUDE <br /> eal Permit Agencye <br /> ' Pennit No DO Permit Date -21-GY_ APNITRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> LFL <br /> NTATION {✓) X VERTICAL —HORIZONTAL —ANGLE —(SPECIFY) Name <br /> ' DRILLING <br /> EPTH FROM METHOD FLUID Mailing Address <br /> SLJ FACE DESCRIPTION $ <br /> to FtDLYCr(be Inaterial grain size, color etc c1TYSTATE ZIP <br /> r O S <br /> S Z i Y Fait- 3v 69 Address- 1111:111,001 _ WE ION 7ti <br /> 10 <br /> City r <br /> r County A <br /> ' <br /> APN Book M33 Page 3 2 Z g . �Parcel, <br /> TownshipTZ�SS' Range 7%S F_Section 2-1 <br /> Latitude 7 NORTH Longitude 4 Z 1 1 �5'o 5 1 WEST <br /> r DEG MIN SEC. DEG MIN SEC <br /> LOCATION SKETCH ACTIVITY (f) <br /> O <br /> NEW WELL <br /> I r .tYn MODIFICATIONIREPAIR <br /> r ' —79 <br /> I[' — Deepen <br /> 5i" <br /> _ Other(Specify) <br /> zf <br /> AL DESTROY(Oescrlbe <br /> r f . Procedures and ArsferWs <br /> under 43 OLOOIC LOG) <br /> SeTr+�� IAICe PLANNED USES (.!!L) <br />' WATER SUPPLY <br /> r r f r Domestic Public <br /> x Irngatlon Industrial <br /> Lu <br /> �[, w MONITORING_ <br /> r i 4aLA� � TEST WELL <br /> a CATHODIC PROTECTION <br /> r HEAT EXCHANGE_ <br /> h 1 <br /> DIRECT PUSH_ <br />' + I INJECTION_ <br /> t I <br /> VAPOR EXTRACTION <br /> SPAAGING <br /> I r <br /> SOUTH REMEDIATION_ <br /> Tlhrstrnfc ur I)cscnbc Dittrnrcr rrf 1V<!I(rrn+r Arrrrdv llurlrllu;n <br /> r I Fmiccv Rrien etc mrd alfnA d r, re nrlrlllru+rrrl 11xrlxr f OTHER(SPECIFY) <br />' I r Recefva i PLEASE BE ACCURATE 6 CQMPLETE <br /> I r WATER LEVEL be YIELD OF COMPLETED WELL <br /> h + DEPTH TO FIRST WATER <br /> (R)BELOW SURFACE <br /> h I DEPTH OF STATIC <br /> WATER LEVEL (FI)&DATE MEASURED <br /> h ESTIMATED YIELD (GPM)d TEST TYPE <br /> TOTAL DEPTH OF BORING (Feet) TEST LENGTH (Hrs)TOTAL DRAWDOWN_ Ft <br /> TOTAL DEPTH OF COMYLk")Y.11 WELL ( ) <br /> {Peet) May not be reprerentative ofu mell!r ng-term yield <br /> DEPTH BORE CASING (S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE HOLE TYPE(') FROM SURFACE <br /> TYPE <br /> Imes u� � a MATERIAL! INTERNAL GAUGE SLOT SIZE CE BEN <br />' Ft to Ft ( ) S`c GRADE DIAMETER OR WALL IF ANY MENT TONITE FILL FILTER PACK <br /> (Inches) THICKNESS (inches) Ft fo Ft (TYPE/SIZE) <br /> h <br /> ------------ <br /> f <br /> 1 <br /> ' 1 <br /> 1 f <br /> I ' <br /> r ATTACHMENTS (.!!L) CERTIFICATION STATEMENT <br /> ...y� Geologic Leg I the undersigned,Certify that this report Is Complete and accurate to the best of my knowledge and belief <br /> ._A_ Werl Construction Diagram NAME <br />' Geophysical Log(s) (PERSON RRM UK CORPORATION) (TYPED OR PRINTED) <br /> — Sol"Water Chemical Analyses 2.AISN <br /> VB CA <br /> Other ADD <br /> CITY STALE ZIP <br /> ATTACH ADDITIONA�INJIIORMA�TIION 1TEXISTS Sghf7f - 6 '70 5gZ-1 <br /> I.I.URIDRI REPRES TIVE DATE SrCNED C 57 LICENSE NtIM9ER <br /> DIVR 1At4 REV 11 Ir IF ADDITIONAL S , E N CONSECUTIVELY NUMBERED FORM <br />