Laserfiche WebLink
ORIGINAL STATE OF CALIFORNIA USE ONLY — D O NOT FILL IN <br /> File with DWR WELL COMPLETION REPORT <br /> Page I of Refer to Instruction Pamphlet STATE WELL NO./STATION NO. <br /> Owner's Well No.—WV4 '(�+1-' 7 -No - .477317 <br /> Date Work Began �-`"1 t Ended 1 ��`l tlJ LATITUDE LONGITUDE <br /> el <br /> Local Permit Age cy ( I. ��' l► <br /> Permit No. a e <br /> Permit D • It 5 9-r, APN/TRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION (`�) VERTICAL _ HORIZONTAL _ANGLE _(SPECIFY) :Mame 1 St_vV r, I � <br /> DEPTH TO FIRST WATER (Ft.) BELOW SURFACE Mailing Address <br /> DEPTH FROM <br /> SURFACE DESCRIPTION <'JCIO,I,� Com• <br /> �— <br /> Ft. to Ft. Describe material,grain siuCITY STATE ZIP,color,etc. WELL LOCATION <br /> enol <br /> Address 3S i OC S l'htiN ?i3 <br /> CI l'L city U _zr1 ci I.2 <br /> 10 t 5 S I I M Ct County �L� ��►� <br /> Cl G1 :Al 1 �� 4 APN Book Page Parcel <br /> or <br /> '✓ Townshi <br /> p Range (,7— Section 4- <br /> ` or <br /> V r'OwiR, mat Latitude NORTH Longitude I I WEST <br /> 1 �1 C.yV. C` DEG. .;IN. SEC. DEG. MIN. SEC. <br /> LOCATiON Sk H TIVITY (iL)- <br /> Q 2f5vt c�, a \r.,: t^ NOR �j <br /> �r ll = NEW WELL <br /> •� r ��OOI MODIFICATION/REPAIR <br /> 5 4alllJ c •Qh'1 _Deepen <br /> m 0l �1 _Other(Specify) <br /> L"h • rr `4��` DESTROY(Describe <br /> -1 I 2. a - Procedures and Metenals I <br /> uJLL-vUnder"GEOLOGIC LOG") <br /> 5 49 Mo Y-4— a N � � � U) PLAN ED USE(S) <br /> w a (�) <br /> w MONITORING r <br /> t N V �� • WATER SUPPLY <br /> Domestic <br /> \ Public <br /> Irrigation j <br /> V <br /> • Industrial <br /> "TEST WELL" <br /> _ CATHODIC PROTEC- <br /> 'OU'' — TION <br /> Illustrate or Desezbe i Ltrance of Well from Landmarks OTHER(Specify) <br /> such as Roads,Buiidings,Fences,Rioers,etc. <br /> PLEASE BE ACCURATE & COMPLETE. <br /> DRILLING <br /> METHOD �t�a� -nr`T A�fi�%�� FLUID <br /> WATER LEVEL & YIELD OF COMPLETED WELL <br /> DEPTH OF STATIC <br /> WATER LEVEL 20 ("(1 (Ft.) & DATE MEASURED � ) 4 L <br /> ESTIMATED YIELD' (GPM) & TEST TYPE <br /> TOTAL DEPTH OF BORING (Feet) TEST LENGTH (Hrs.) TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL 4b•5 (Feet) `May not be representative of a well's long-tern yield. <br /> DEPTH CASINGS) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE BORE- TYPE FROM SURFACE TYPE <br /> HOLE — <br /> INTERNAL GAUGE SLOT SIZE <br /> DIA. z d MATERIAL/ CE- BEN- <br /> (Inches) DIAMETER OR WALL IF ANY FILTER PACK <br /> a o GRADE MENT TONITE FILL <br /> Ft. to Ft. in � c» � (Inches) THICKNESS (Inches) Ft. to Ft. (TYPE/SIZE) <br /> U 13 4D lJ o 0 2D 1 TL <br /> 24. 4 S k C 2 5cn4o 0.01 ?.0 ✓ N <br /> -49 Z <br /> TTACHMENTS (:) 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 /> � \ � � <br /> Well Construction B (�tat,. F-fL(ACJ. NAME (_522 <br /> `p0 �/_; <br /> (PERSON. FI R CORPORATION) (TYP OR PRINTED) <br /> Geophysical hernidLog(s9s�' ���� /�, / ��/�Q� �� �5/�T_3 <br /> Soil/ ter Chemicyl Analyses //`{.�(./^/ r <br /> ` ADDRESS CI STATE ZIP <br /> 4 Other i� I / <br /> ATTACH ADDITIONAL INFORMATION. IF IT EXISTS. Signed �!1 <br /> WELL DRILLER/A HORIZED REPRESENTATIVE DA E SIGNED C-57 LICENSE NUMBER <br /> DWR Inh REV.7-90 IF ADDITIONAL SPACE IS NEEDED, USE NEXT CONSECUTIVELY NUMBERED FORM <br />