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ORIGINAL STATE OF CALTFORNSA D O LY <br /> File w� i DWR 2 WELL COMPLETION REPORT 11_ . Iy� <br /> I- <br /> Refer to Instruction Patrrpblet STATE WELL NO./STATION NO. <br /> ,Gage_of <br /> Date 'S Well Na. 7/ f 7 f� 1 6%1 8 <br /> Date Work Began d !! °'f' f LATrr(mE LONGITUDE <br /> Ail° PUB. HEALTH <br /> Local Permit Agenc� <br /> Permit No. Permit Date APNITRSIO ER <br /> X GEOLOGIC LOC QH -TERES ELL OWNER <br /> , <br /> � <br /> ORIENTATION (✓) __VERTICAL _HORIZONTAL .C)r .ANGLE _(SPECIPY) Nan : + <br /> J' CA— <br /> DEPTH FROM DEPTH TO FIRST WATER (FL)BELOW SURFACE r :Ad 1• <br /> SURFACE DESCRIPTION \�� '"' ' +• <br /> FL o FSTATE Zip EH "TA <br /> r,daSAND 1% 1resa'r r <br /> Y (z <br /> 22 —BROWN �. + Y i a <br /> 46 4:9 SA14D <br /> ' - APN Book 311, *Page_$E _Parcel <br /> �:~ '- -^� TQ ri hiP Range Section <br /> Ltittxde r NORTH Longitude Ir <br /> WEST <br /> • ` (�^; DEC, MIN. SEC, DEQ MIN. SEC. <br /> DE <br /> r LOCATION SKETCH- ACTIVITY(L)-- <br /> ` ` t� +• /� NORTH NEW WELL <br /> r,, \ - `14) <br /> MODIFICATIONIREPAIR <br /> ` Deepen <br /> r r e 3 Dfvjvwvf� .CL t: <br /> • G Other(Specify) <br /> —+t <br /> r a . <br /> ,,v �..DESTROY(Dosedbe <br /> Pracedwea end Melertata <br /> ` vp' ` Under"GEOLOGICLOG'9 <br /> ® m y PLANNED USES]- <br /> GRAY CLAY <br /> aa ✓ <br /> 2rs4 28d ED RM Oil"--11 CtAY AND SAN- + W .—. MONITORING <br /> 9 PINK Ctn'lr 1 GUG111 <br /> WATER SURLY <br /> Domestic <br /> 303 SAND _ PubIPo <br /> 49 --?%e-L <br /> 3013-0 =5 BROWN CtAY AND SANMT_­_ <br /> _ tnlaatbn <br /> 31 <br /> r r <br /> Industrial <br /> =4 St! StACK SPECKS r <br /> _ "TEST WELL" <br /> SOUTH —CAT ODIC PROTEC- <br /> TtOIllustrate or Describe Distance of We"from Landmarks —OTHER(Specify) <br /> 321 334 SAND WfTH tENSES PLEASh asE BE,ACC(URATE&COMPPLETX <br /> 324 3= Of CLAY DRILLING ('•IUD ROTARY WATER <br /> ;3;3!2 359 TOMH-GRAY A 1D METHOD FLUID <br /> 55i PINK WATER LEVEL & YIELD OF COMPLETED`WEL� <br /> DEPTH OF STATIC 0 <br /> 551 ;36-Q,-BROWN --eE:AY AND SANDSTONE WATER LEVELO(Ft.) &DATE MEASURED <br /> 575 <br /> ESTIMATED YIEL&_(GPM) &TEST TYPE <br /> TOTAL DEPTH OF BORING (Feet) 0 TEST LENGTH (Hrs.)TOTAL DRAWDOWN (FtJ <br /> TOTAL DEPTH OF COMPLETED WELL (Feet) 'May not be representative of a wdh long-term yield <br /> DEPTH CASINGS) DEPTH <br /> MATERIAL <br /> FROM SURFACE BORE- TYPE ✓ FROM SURFACE TYPE <br /> HOLE — INTERNAL GAUGE SLOT SIZE <br /> DIA z "' MATERIAL/ CE- BEN <br /> pnches) IS ze GRADE DIAMETER OR WALL IF ANY MENT TONRE FILL FILTER PACK <br /> Ft. to Ft. v -+ Onches) THICKNESS finches) Ft. to Ft. (TYPE/S12E) <br /> (11) (4) (4) <br /> i <br /> . i88r <br /> - r <br /> 1 19 <br /> r ' • , <br /> r <br /> ATTACHMENTS (j�.) CERTIFICATION STATEMENT <br /> 1,the undersigned,certify that this report Is complete and accurate to the best of my knowledge and belief. <br /> WONcansttuction Diagram NAME_ <br /> Geologic Log PURVIANCE DRILLERS, INC. <br /> _ aH ' <br /> (PERSON,FIRM+OR CORPORATION) (TYPED OR PRN(TED) <br /> _. Geophysical Log(s) PSoll/ . ®. $®}( 44 L N, CA, 95235 <br /> — <br /> Other <br /> Water Chemical Analyses ADDRESS CITY STATE ZIP <br /> _. Other - 37923 <br /> ATTACH ADDITIONAL WFORMATIDN.r rr Evsra Slgn <br /> tL DRRLER/AUTtIORPF DATL SIGNED C-57 LICE= NUMBER <br /> DWR ISS REV.7.00 IF ADDITIONAL SPACE IS NEEDED, US EXT CONSECUTIVELY NUMBERED FORM <br />