Laserfiche WebLink
ORIGINAL STATE OF CALIFORNIAN Y — 00 HOT FIki <br /> Fite with DWR WELL COMPLETION REPORT o1 i lot 1E1L tivy <br /> Page_of Refer to hrstrrrctiort Pampblet STATE WELL NOJSTATION NO. <br /> Ownees Well No. No. 412227 I-.V ] 71 <br /> Date Work Began , Ended LATITUDE LONGITUDE <br /> Local Permit Agey — <br /> AFIMMSIOTHER <br /> Permit No. c•'` Permit Date <br /> --- GEOLOGIC LOG ` ;WELL OWNER <br /> ORIENTATION (4} VERTICAL _HORIZONTAL _ANGLE _(SPECtm Name <br /> DEPTH TO FIRST WATER (FL)BELOW SURFACE 1�Iailig=Addre�5 s =•~ F�- <br /> DEPTH FROM ;. i: , .+y •� t �, ti <br /> SURFACE DESCRIPTION <br /> Ft. to Ft. Daeribematerial, ainsize,Color.do. ,`<< • TM• t, 5� i tj STATE ztF , <br /> 19ELL•' 0 T O <br /> j aAd4re55"• :> <br /> r 1 t ..- :^ 4 • - "^ <br /> lot-- <br /> YCOU �y '.,,.. <br /> (17 6r ��-` Na '^ ' �APN Book W' Iiage Parcel d <br /> or•-. np <br /> A• •_ - " ' `• `• TgWnship 0,3" Range�Section <br /> 6;1;4 ' CKA ' .� •` 1 `,,t,� ` f 4" f r r NORTH r a WEST <br /> _ rI li tide, Longitude <br /> DEG. MW. SEC. DEG. MIN. SEC. <br /> LOCATION SKETCH ACTIVITY (4)— <br /> % 'r', NORTH <br /> NEW WELL <br /> t� MODlFICATtON7REPAIR <br /> v N Deepen <br /> a 1 { @ �1 Other(Specity) <br /> r t aIRIAtAL <br /> ' , 9'1 - �%��\` _DESTROY(Describe <br /> rr Procedures end Materiels <br /> r --'r Z`, Under"GEOLOGICLOG" <br /> PLANNED USE(S) <br /> rn ✓ <br /> MONITORING <br /> r WATER SUPPLY <br /> i a �Domeat(c <br /> •Public <br /> AdMkIrrigation <br /> a i <br /> Industrial <br /> "TEST WELL" <br /> CATHODIC PROTEC- <br /> SOUTH TION <br /> a Illustrate or Describe Distance of Well from Landmarks (specify) <br /> such as Roads.Safld(nggss Fences.Ricers,etc. <br /> PLEASE HE ACC(1RAT'E 1s COMPLETE. <br /> r r <br /> DRILLING <br /> i r METHOD ss FLUID <br /> WATER LEVEL h YI tLD OF COMPLETED WELL <br /> r DEPTH OF STATIC <br /> WATER LEVEL (FtJ & DATE MEASURED <br /> ' ESTIMATED YIELD* (GPM) &TEST TYPE <br /> TOTAL DEPTH OF BORING (Feet) TEST LENGTH Mrs.)TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL (Feet) 'May not be representative of a well's long-term yield. <br /> DEPTH SORE- CASING(S) DEPTH ANNULAR MATERIAL <br /> ✓ <br /> FROM SURFACE HOLE TYPE — FROM SURFACE TYPE <br /> DIA. INTERNAL GAUGE SLOT SIZE CE- SEN- <br /> Rw!� MGRADE I DIAMETER OR WALL IF ANY MENT TGNITE FILL FILTER PACK <br /> FL to Ft. (inch..) THICKNESS pnches) FL to Ft. (TYPE:/SIZE) <br /> W70 <br /> ry 4 , y <br /> r �.+ , <br /> a ' <br /> � r <br /> ATTACHMENTS (!) CERTIFICATION STATEMENT <br /> Geologic Log i,the undorsigned,cert f hat this report)s complete and accurate <br /> accurate to theebest of my knowledge and belief. <br /> Wad Conatruotloe Diagram NAME <br /> ( .RRM,OR CDRPOR!(TIOM((TYPEDOR PRI��NIE(D) <br /> — GeophyslcalLog(s) <br /> VA RA)e �� � <br /> ,—.. Sop/Water Cherrdeal Anayaes 1 U ACITT ATE <br /> ZIP <br /> _ Other <br /> Signed <br /> ATTACH ADt)JTJONAL JNFORMATJOAG 1F lT EXISTS. ad Laa R¢ED REPRESENTATIVE DATE SKINED 7 LICENSEE NUMBER <br /> DWR 388 REV.7-00 IF ADDITIONAL SPACEI NEED D. USE NEXT CONSECUTIVELY NUMBERED FORM 17 <br /> j� <br />