Laserfiche WebLink
ORIGINAL STATE OF CALIFORNIA —DWR USE ONLY - 00 NOT FILL IN — <br /> File <br /> N — <br /> FiIF with DWR WELL COMPLETION REPORT <br /> Page 1 Of .L Refer to Instruction Pamphlet STATE WELL NO./STATION NO. <br /> Owner's Well No. ` f ' NO. 477316 E <br /> Date Work Began 9ttEnded 'I`r `l �y LATITUDE LONGITUDE <br /> Local Permit cv t YILL I I I <br /> Permit No. Permit Dat i, I ( <br /> S I APN/TR / TH R <br /> GEOLOGIC LOG ( ^ WELL OWNER 7- <br /> ORIENTATION (`�) VERTICAL _ HORIZONTAL ��_ ANGLE _(SPECIFY) Name ��?��./'��' 6:.� I�11'�✓�/1 <br /> DEPTH TO FIRST WATER ,T� (FL) BELOW SURFACE Mailing Address 35koC �, +f�AI►/ -i7j <br /> DEPTH FROM \r <br /> SURFACE D E S C R I P T 10 N Y-(.-V'Y)0..11!_f r..Q� <br /> Ft. to Ft. Describe material,,grain Size,,color,etc. WELL LOCATION STATE ZIP <br /> U I ) <br /> rylol<r Address S. 0wy 31� <br /> hl S�CA l. CitV nCut S (,A <br /> I lQ Lw I G J h County 1 r.�Qv 1 fJ <br /> CCL APN Book Page Parcel <br /> J�j O Co or <br /> Township '��_ Range _Section `� 4 <br /> or <br /> Latitude I NORTH Longitude WEST <br /> DEG. MIN. SEC. DEG. MIN. SEC. <br /> 5 l , lo LOCATION SKETCH 1CTIVITY (!)— <br /> p �. NORTH <br /> kro, S1 c_ tt \s�= NEW WELL <br /> \},���pD 1 MODIFICATION/REPAIR <br /> _Deepen <br /> O _Other(Specify) <br /> ei SAr cl�c L ` \ / <br /> acN� —DESTROY(Describe <br /> Procedures and <br /> Under"GEOLOGICIC LOG'' <br /> (CL w N � PL NNED USE(S)- <br /> At � r C.t qtb finals U- 3 vn w (—) <br /> MONITORING <br /> WATER SUPPLY <br /> M� I \ Domestic <br /> 1"1 � <br /> Public <br /> ' g Irrigation <br /> i <br /> Industrial <br /> ' <br /> ..TEST WELL" <br /> CATHODIC PROTEC <br /> SOUTH TION <br /> Illustrate or Describe Distance of Well from Landmarks OTHER(Specify) <br /> such as Roads,Buildings,Fences.Rivers,etc. <br /> PLEASE BE ACCURATE & COMPLETE. <br /> DRILLING <br /> METHOD - tAoC FLUID <br /> - <br /> WATER LEVEL & IELD OF COMPLETED WELL <br /> DEPTH WATER a E ELATIC 3Z•An I <br /> (Ft.) & DATE MEASURED <br /> 4 ESTIMATED YIELD (GPM) & TEST TYPE <br /> TOTAL DEPTH OF BORING 194Feet) n TEST LENGTH (Hrs.) TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL 49 (Feet) 'Afay not be representative of a well's long-term)field. <br /> DEPTH CASING(S) ANNULAR MATERIAL <br /> FROM SURFACE BORE- DEPTHHOLE TYPE '� FROM SURFACE TYPE ' <br /> DIA. r z zf MATERIAL/ INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> (Inches) = z� a DIAMETER OR WALL IF ANY MENT TONITE FILL <br /> Ft. to Ft, < o GRADE FILTER PACK <br /> m H c o (Inches) THICKNESS (Inches) Ft. to FL (TYPE/SIZE) <br /> 2-4 PVC_ $ ), 40 CD T II <br /> 24- k V c (� ✓ Ch s <br /> I <br /> ATTACHMENTS (2:L) CERTIFICATION STATEMENT <br /> Geologic Log <br /> I,the undersigned,certify that this report is complete and accurate to the best of my knowledge and belief. <br /> r ��/n/�/ � <br /> Well Construction 849rem l Q AAACII NAME / PiPP 41rl <br /> Geophysical Log(s) <br /> (PERSON, FI CORPORATION) (TYPEDYbR PRINTED) <br /> r/� <br /> Soil/Wqr Chemise nalyses ADDRESS 1 V <br /> ((LLpp <br /> other <br /> �SZ*�L CITY STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION. IF IT EXISTS. Signed <br /> wtLl URfLLER/AUTHORIZED REPR SENTATIVE DATE SIG ED C-51 LICENSE NUMBER <br /> DWR 188 REV.7-90 IF ADDITIONAL SPACE IS NEEDED, USE NEXT CONSECUTIVELY NUMBERED FORM <br />