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N) <br /> ORIGINAL. STATE OF CALIFORNIA DWEI USE ONLY — DO NOT FILL IN <br /> File with DWR WELL COMPLETION REPORT <br /> Page—Of — h <br /> Refer to ,atnrction Pdnrphlet STATE WELL NOISTATION NO <br /> Owner's Wel['Nom S No ❑ ❑ <br /> weal <br /> Work Began lI a`1C.lO E ed e�00S LATITUDE LONGITUDE <br /> Pennit Agency In <br /> Permit No Permit Date O J& <br /> APNrrRSlOTHER <br /> GEOLOGIC LOG WELL OWNER <br /> OAI ENT'ATION (_) VERTICAL —HORIZONTAL —ANGLE <br /> DRILLING —(sPEctFq Name Paw <br /> DEPTH FROM METHOD FLUID ling Address 0• X 5 <br /> (49 <br /> SURFACE DESCRIPTION 70 <br /> FL to PL Describe material grain size, calor etc CITY STATE ZIP <br /> _ <br /> W L LOCAT <br /> I! Aadress A-)' <br /> le_5aE: City c <br /> I , <br /> County n oa <br /> APN Book Page- ParLvi 80X0 <br /> Townshl S�/ -Ran� ppz�e Sechnn <br /> kAW7LatitudS'7 I 4!5. 447 NORTH 1-ongltude al J& 4 WEST <br /> I , DEQ MIN SEC DEG MIN SEC <br /> 1 I <br /> Z� LOCAT ON�SKETCH ACTIVITY (4) <br /> NOH <br /> via UNEW WELL <br /> ino +_ MODIFICATIONIREPAIR <br /> t t � -avi —5 I ti-i e C' .<_IkAj Deepen <br /> fttRIkta1 ��� �e I r ' Othar(Specify) <br /> 14 <br /> _ef DESTROY(Daacribr <br /> Procedures and Matariala <br /> �.3. Under"GEOLOGIC LOG J <br /> ' ' V PLANNED USES ('') <br /> WATER SUPPLY <br /> 1 1 _ Domestic — Public <br /> I 1 <br /> y t- Irrigation _ Industria, <br /> I 1 MONITORING <br /> TEST WELL <br /> CATHODIC PROTECTION_- <br /> I 1 HEAT EXCHANGE <br /> DIRECT PUSH <br /> INJECTION <br /> I I VAPOR EXTRACTION�- <br /> ' I SPARMNG <br /> I 1 SOUTH REMEDIATION <br /> Illnstrnte or Lkxcrlbe DLrtrmcr if WrIt finel Arndr Haddhigs <br /> 1 1 Farms R)tRrs rte and rmrrcl,a nurp Use additional�x+�rr f� OTHER(SPECIFY) <br /> neeessrtn) PLEASE BE ACCURATE it COMPLETE <br /> 1 1 <br /> 1 1 <br /> WATER LEVEL bt YIELD OF COMPLETED WELL <br /> DEPTH TO FIRST WATER (FI)BELOW SURFACE <br /> F DEPTH OF STATIC <br /> WATER LEVEL (FI)6 DATE MEASURED <br /> ' 1 ESTIMATED YIELD (GPM)a TEST TYPE <br /> TOTAL DEPTH OF BORING (Feet) TEST LENGTH (Hrs)TOTAL DRAWDOWN— (Ft) <br /> TOTAL DEPTH OF COMPLETED WELL (Feet) MO not be represen=ve of a aren't long-terns yield <br /> DEPTH BORE CASING (S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE HOLE TYPE ' FROM SURFACE TYPE <br /> (DNAs) MATERIAL INTERNAL GAUGE SLOT SIZE CE BEN, <br /> FL to Ft GRADE DIAMETER OR WALL IF ANY MENT TONITE FILL FILTER PACK <br /> (inchas) THICKNESS {Inctles) FL to Ft ITYPEJSIZE) <br /> I <br /> ji <br /> I <br /> I <br /> 1 I <br /> ATTACHMENTS (:) CERTIFICATION STATEMENT <br /> Geologic Loy I,the Undersigned,certify that this report is complete and accurate to the best of my knowledge and belief <br /> _ Well Conahuctfon Diagram NAME LJ L C 0 iV C <br /> Geophye(eal l.og(s) KRESOK FIRM OR CORPORATION) (TYPED OR PRIfYrED} Of <br /> % <br /> /Solll Wate�ml alyses y lS. �1�s T/Q <br /> .._ Other ADDRESS CITY i STATE ZIP <br /> r <br /> ATTACH ADDITIONAL INFORMATION IF IT EXISTS S� a R. O 7 <br /> WEf!L ORILLERIAUTH D REPREsmrmw DA SIGtt C-1 LICENSE NUMBER <br /> L)LVft IPA REV its IF ADDITIONAL SPACE IS NEEDED, USE NEXT CONSECUTIVELY NUMBERED FORM <br />