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71 <br /> ORIGINAL STATE OF CALIFORNIA DWR USE ONLY — DO NOT FILL iN <br /> File with DWR WELL COMPLETION REPORT 111111111111 <br /> Page--L Of—L Refer to Lista ucttou Pamphlet STATE WELL NO/STATION NO <br /> Owner's Well No ' •�` No 823397 LATITUDE ❑ LONGITUDE <br /> Date Woik Began ¢ Ended_ } �; <br /> Local Permit Agency A I "� r 14 P-9,9 <br /> GEOLOGIC <br /> Pernut No �/3 ra Permit Date <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION —VERTICAL —HORIZONTAL —ANGLE —(SPECIFY) Name sMilitiql1l. o t r' <br /> N A DRILLING Marlin Address 91 <br /> DEPTH FROM METHOD FLUID g <br /> SURFACE DESCRIPTION CITY STATE ZIP <br /> CA 94551: <br /> Ft to Ft Describe material grain SIZ( color cteWL LOCATION <br /> Address �- <br /> City D <br /> { h County Sigh Tvagial* <br /> Weky Witk10: t -eAPN Book Page Parcel <br /> ' ,124U%1'11 is rt Township Range Section <br /> to Latitude I I NORTH Longitude_ I WEST <br /> DEG MIN SEC DEG MIN SEC <br /> LOCATION SKETCH ACTIVITt (2L) <br /> I I NORTH NEW WELL <br /> t r MODIFICATIONIREPAIR <br /> t �... Deepen <br /> Other(Specify) <br /> t s <br /> F_ M A /' DESTROY(Describe <br /> Procedures and Materials <br /> t s A T r Ar c 4 r p Under GEOLOGIC tOG J <br /> PLANNED USES (:) <br /> i WATER SUPPLY <br /> Donleslhc Public <br /> I I Irrigation industrial <br /> I I 3 MONITORING— <br /> I I <br /> TEST WELL- <br /> I I CATHODIC PROTECTION <br /> f NEAT EXCHANGE - <br /> DIRECT PUSH <br /> INJECTION - <br /> I I VAPOR EXTRACTION <br /> i I SPARGING <br /> SOUTH REMEDIATION.�..,, <br /> Illumatc of Dcscidg Distance of W411 front Roads Buildups <br /> Fences Rai ers etc find attach a ata Use additional ppaper If OTHER(SPECIFY) <br /> nccessanj PLEASE BE ACCURATE&COMPLETk <br /> WATER LEVEL & YIELD OF COMPLETED WELL <br /> I I <br /> DEPTH TO FIRST WATER (Ft) BELOW SURFACE (�[ ,A <br /> DEPTH OF STATIC <br /> WATER LEVEL (FI)&DATE MEASURED <br /> ESTIMATED YIELD (GPM) & TEST TYPE <br /> TOTAL DEPTH OF BORING (Feet) N f1 A TEST LENGTH (Hrs) TOTAL DRAWDOWN (Ft) <br /> TOTAL DEPTH OF COMPLETED IVELL (Feet) 'Miry not be representative ofa well's long-neon yield <br /> DEPTH CASING (S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE BORE HOLE TYPE FROM SURFACE TYPE <br /> DIA Y z ¢ a MATERIAL 1 INTERNAL GAUGE SLOT SIZE CE BEN <br /> W O FILTER PACK <br /> pnches) Z w z� a GRADE DIAMETER OR WALL IF ANY MENT TONITE FILL <br /> Ft to Ft m c¢i c�s� zj (Inches) THICKNESS (Inches) Ft to Ft (TYPE/SIZE) <br /> rn o LL (,) OL) (4) <br /> t ' <br /> t <br /> I I <br /> I <br /> I ' <br /> I r <br /> ATTACHMENTS CERTIFICATION STATEMENT <br /> I the undersigned certify that this <br /> l ireport Is complete and accurate to the best of my knowledge and belief <br /> Y <br /> — <br /> Geologic Log * w p T I `S�h T-}'1 c! <br /> Well Construction Diagram NAME(PERSON FIRM OR CORPORATION) (TYPED ORPRINTED) <br /> Geophysical Log(S) k V• n I `c 1 t3 <br /> Soilfwater C emtc l nalyses <br /> Other SIM Q P ADDRESS CITYry STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION IF IT EXISTS Sign 7 A3 110304 <br /> L RI O IZ D EP NTATI E SI ED C 57 LICENSE NUMBER <br /> I)ts it lu RLs 11 97 IF ADDITIONAL SPACE IS NEEDED USE NEXT CONSECUTIVELY NUMBERED FORM <br />