Laserfiche WebLink
S) <br /> ORIGINAL STATE OF CALIFORNIA RWR USE ONLY. — DQ NOT FILL <br /> Pile with DWR WELL COMPLETION REPORT <br /> Page—of Refer to Instruction Pamphlet STATE WELL NO tSTATION NO <br /> Owner's Well No <br /> W:Pen:t <br /> rkBanl � , Ended fi LATITUDE LONGITUDE <br /> Agency. Cv v r, <br /> Permit No QL Permit Date 70 APNrrRSIOTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION (4) v y/ERT1CAL ,,,_HORMNTAL —ANGLE _(sPEcim Na <br /> DRILLING <br /> DEPTH FROM METHOD FLUID M ng Address <br /> SURFACE DESCRIPTION 9 <br /> R W FL Describe )naterial grain size, color etc CITY STATE ZIP <br /> Address a ELL LOCATLDN <br /> rd Vq <br /> I 1 L 5°7 city r'�r <br /> I I <br /> County a <br /> APN Book Page Parcel oa-� <br /> 3 Townsh>.p�'` Ran a.��+=Sechon <br /> { Ti_ I RTH <br /> I Iatztude_31 t � Longitude 1-2-11 a� 1 � wEsr <br /> 1 1 DEG MINSEC DEG MIN SEC <br /> LOCATION SKETCH ACTIVITY (t) <br /> r 1 VI NORTH <br /> ._ NEW WELL <br /> 1 <br /> MDDIFICATIONIREPAIR <br /> I 1 +-{- 5 117 5 ��. Deepen <br /> 1 � Other{SpeclfY) <br /> 1 ' � DESTROY(Deserlbe <br /> Proceduros and INaferlafs <br /> r ' Under GEOLOGIC LOG) <br /> PLANNED USES { ) <br /> s 1 WATER SUPPLY <br /> Dornssha — Public <br /> 1 1 <br /> Irripe[lon Industdel <br /> I 1 <br /> MONITORING�. <br /> 1 1 TEST WELL.�. <br /> 1 1 CATHODIC PROTECTION <br /> HFAT EXCHANGE `._. <br /> 1 1 DIRECT PUSH <br /> 1 1 <br /> INJECTION <br /> I 1 VAPOR EXTRACTION <br /> 1 1 SPARGING <br /> 1 1 <br /> Illustrate ur lkxcr7la DiKapier llee g 1 f�Vr!lfrruu Raedx Bx[lrl8ly+x REMEDIATION <br /> r 1 Fences Rkers etc and attach now))�Use add)ttonal!K�ilns! OTHER(SPECIFY) <br /> necestang PLEASE BE ACCURATE U COMPLETE <br /> 1 1 <br /> WATER LEVEL & YIELD OF COMPLETED WELL <br /> I 1 <br /> 1 DEPTH TO FIRST WATER (FL) BELOW SURFACE <br /> I 1 DEPTH OF STATIC <br /> WATER LEVEL (Ft)A DATE MEASURED <br /> r r ESTIMATED YIELD' (GPM)a TEST TYPE._. <br /> TOTAL DEPTH OF BORING (Feet) TEST LENGTH (Hra)TOTAL DRAWDOWN_ (FI) <br /> TOTAL DEPTH OF COMPLETED WELL (Feet) •May not be representeTwe o e meU's loft tmn yield <br /> DEPTH BORE CASING (S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE HOLE TY f TE ' FROM SURFACE: TYPE <br /> DIA ^ ' MATERIAL! INTERNAL GAUGE SLOT SIZE CE DEN <br /> Fe FL (Inches) GRADE DIAMETER OR WALL IF ANY MENT TONME FILL FILTER PACK <br /> (Inches) THICKNESS (Inches) FI to FL (�) (�) f T) (T`/PEJSIZE) <br /> 1 <br /> I r <br /> I <br /> 1 I <br /> r r <br /> 1 1 <br /> ATTACHMENTS (T) CERTIFICATION STATEMENT <br /> _ Geologic Log t,the undersigned, certify that this report Is complete and accurate to the best of my knowledge and belief <br /> Well Consbirtion Diagram NAME rte- /�+�• <br /> Gewhysloal Log(s) (PERSC DN, FIRM,fO,R CDRPORATION) D OR PRINTED) ♦� r}� q <br /> _,Soil/Water hemi lveee S�Q �d U�Zy' �0 _-�!r�s r'`, (�iq <br /> J� OtherI ADD�4)R�ILLERJAUTRIZED <br /> CRY STATE ZIP T <br /> � '7/447? <br /> i9TTACH AODIrtOAtAL lNFORAfA710 , !F IT EXISTS PRESENTATIVE DAW SIGNEII C 57 LICENSE NUMBER <br /> DWR IFA REV )l-sr, IF ADDITIONAL SPACE IS NEEDED, USE NEXT CONSECUTIVELY NUMBERED FORM <br />