Laserfiche WebLink
N'I �ReGw�h DWR � ` `'� � STATE or CALIFORNIA <br /> SE ON --- D ! <br /> WELL COMPLETION REPORT <br /> Page. of Refer to lusiructton Pampblet STATE WELL NO/s ATtON NO <br /> Owner s Well No No 412 219 <br /> Date Work Began Ended LATITUDE LONGITUDE <br /> Local Permit A91 L3M AnTJ// _ _ _ <br /> ' <br /> Pertnrt No . A ,.' ,_...R_70 _,..Fermat Date AP ! R <br /> GEOLOGIC LOG --,WELL OWNER <br /> ORIENTATION (.:C) —VERTICAL —tioRizoNrAL —ANGLE _(SPECIFY) NaM A4 NkLXI <br /> DEPTH TO FIRST WATER{ (Fl.)BELOW SURFACE `Maillmg rens <br /> DSURFACEM DESCRIPTION I ' <br /> +; <br /> FI to Fe Ihrtrrbe trtuter:al Bram art,talar ere • `� CITY , & ', : t STATE ZIP <br /> 1 i WELL LOCATION <br /> AdJrV. , <br /> 1 + 1 City <br /> ' ~� TA 11" <br /> QL "` APN <br /> lt�y <br /> g Parcel 0YTowtanW13 J:M ton <br /> ` �' Lsi4ltude NOR Longitude_ wear <br /> DEG- MIN SEC. DEG � MIN SEC <br /> LOCATION SKETCH AC�YVITIf (✓y <br /> ` ` t *�. i, r� -' ` NORTH <br /> 1 t ♦ a Fi NEW ywr:LL <br /> 99 ; 17 `k L ' ` �t78 t <br /> IN ! A ODI Nl EPAW <br /> , ^Diher(Specny) <br /> l <br /> DEMOY(Desaroo <br /> ProcedsaasandMsfedafs <br /> thldsr"CIEOLOWULOO') <br /> w a PLANN9 D)USB(S) <br /> MONITUMNe <br /> NATER SUPPLY <br /> 1 I <br /> Domestic <br /> r <br /> Publle <br /> ' trrlgaElaa <br /> 1 1 <br /> 1 <br /> tndwhiai <br /> i + i s siN 'TEST WELL <br /> ' ` t SOUTH —CATHODIC PROW> <br /> TION <br /> r 1 V <br /> ' illustrate or Describe Oisiance of Well frarn landmarks 07119R(Specify) <br /> such as Roads,Bulldinas Fences Rivers,etc <br /> PLEASE BE ACCURATE d COMPLET& <br /> DRILLING <br /> METHOD LSV �7 • PUY _ Y i. . <br /> METHOD v 7 • FLUID— <br /> 1 1 y <br /> WATER LEVEL b YIELD OF COMPLETED WELL <br /> DEPTH OF STATIC <br /> WATER LEVET (Ft) a DATE MEASURED <br /> + F ' ESTIMATED YIELD (GPM) S TEST TYPE <br /> TOTAL, DEM OF BORING (Feet) TEST LENGTH Mrs)TOTAL DRAWDOWN (Fta <br /> TOTAL DEPTH OF COMPLETED WELL _ (Feet) *May net be repramatsve of a wdi's lmig-term yield <br /> DEPS CASIhG(S) DEPTH ANNULAR MATRRIAL <br /> FROM SURFACE H LE TYPE ! FROM SURFACE TYPE <br /> DIA i 0 rr ,,, INTERNAL GAUGE SLOT SIZE <br /> MATERIAL! CE- 7BMr:3"Em OR WALL IF ANY CENT FILLFt to Ft (k'd1es) °L GRADE FIl7ER PACK <br /> LL (Taches) THtCKNE83 O„rhas} Ft to Fl (�1 (�) {TYPE/SIZE) <br /> 1 C, Vigo ; ZAO <br /> 1 , <br /> 1 <br /> ATTACHMENTS CERTIFICATION STATEMENT <br /> Geologic Lou i 1,the under ned,ce#rtfly���i that th report Is com tete and accurate yto the beat o1ff m knowledge and belief <br /> — Well Construction Diagram NAME...� ■ r `.a !1/ •V <br /> 6aophyalcsl Lag(e) <br /> (rIXON R �OR CORPORATION)()1I OR FRUITED) - + <br /> br <br /> — sop/Water Chemfoat Analyses ;- -+ „A oy I V- r�✓ ��� C <br /> AOEIitE$S ' CITY. STATE EN `. <br /> -� other o- <br /> ATTACH ADVMO14AL InFOAMATION iF IT FJ@3Ta Signed GARTER A"gr" Mus"4TATIVE OATS SIGNED T Y C57 �NUDABER- <br /> .DWRaasREv 7fjo IF ADDITIONAL SPACE IS NEEDED, USE NEXT CONSECUTIVELY NUMBERED FORM J�p <br />