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Al S �� / II:�• f'.11.1 h11R�1.1 DWR USE ONLY DO NOT FILL IN <br /> File with DWR <br /> WELL COMPLETIOL REPORT <br /> haL�N_OF- lSr•f�a' !a 111-11u H-1.I'nu,phlet aTATE WELL NO./STATIOPI NO, <br /> (hvner's bitcll No. <br /> NO. 729532 E11=71CI <br /> ]);It(, \Vlrk Br•"ranC, Entl(`fl_11j11410 LATITUDE <br /> LONGITUDE <br /> Local Permit Awvire° <br /> h!`t'111It No. Permit I)att• APN/TRS/OTHER <br /> GEOLOGIC LUG C- NVELL OIVNER <br /> ORIENTATION II --"VERTICAL __HORIZONTAL _ANGLE ——(SPECIFY) Name N.uttJ9 !®k ( <br /> Cc,." <br /> a« <br /> bJlG 4kIkC'DAILLINGnn <br /> DEPTH FROM METHOD MFLUID Mailitl(; A(tfi 0. SOt �Qjet <br /> SURFACE DES RIPTION ,sF�c��b,-t <br /> Ft. to Ft. Dr•w•ribe urtltr•rial• grntrl.SL:r', rrllrll', Plt'. CITY aTATE <br /> ZIP <br /> S' �' <br /> Address <br /> L ,ATION <br /> c" Cih• <br /> Ctt1(tth Sea,► t�/fT7 <br /> APN R(X)k Parry <br /> P;ur(`l <br /> Tt)amsltii) r, <br /> 4 <br /> 12- <br /> I Ranke tit Ctl(11t <br /> L' ti(le'_ 1 t NORTH L011'�Itll(IN •I 1 WE <br /> Z _ r✓L DEG. MIN. SEC. DEG. MIN. SEC. <br /> ,3 , ' r ; LOCATION SKETCH A TIVITY !=) <br /> / �w NORTH <br /> J G _ NEW WELL <br /> Z I I S` .. /'4 L MODIFICATION/REPAIR <br /> �j� p Deepen <br /> S I p O I `-•r"C�C_. — Other(Sp®cifyl <br /> Ir <br /> 00� � Q _ DESTROY(Describe <br /> Procedures and Mater <br /> Sty,. S 5- Under"GEOLOGIC LC <br /> PLANNED USES (s <br /> S �'f WATER SUPPLY <br /> ' I _ Domestic ._ public <br /> In F- _ Irrigation _ indust <br /> LU in <br /> w MONITORING <br /> 1�S♦ t , C TEST WELL_ <br /> 1 f CATHODIC PROTECTION_ <br /> Ir " DIRECT PUSH <br /> HEAT EXCHANGE_ <br /> ^/ CfR — G ) _ <br /> eg J INJECTION_ <br /> r a, ro elk �.J G VAPOR EXTRACTION_ <br /> 1 , •j 3 K SPARGING_ <br /> SOUTH REMEDIATION_ <br /> Illustrate or Desc•ri6e Distance of 1T elf fium Boucle.Buil(ligs. <br /> Y t1 S' Fences.Ricers•etc.ano'rrttrrch a nm . I're additional poper if OTHER(SPECIFY)_ <br /> i necesrnn/.PLEASE BE ACCURATE C031PLEIT <br /> I ItTER LEVEL & YIELD OF COMPLETED WELL <br /> DEPTH TO FIRST WATER O X(Ft.) BELOW SURFACE <br /> DEPTH OF STATIC <br /> WATER LEVEL (Ft.)&DATE MEASURED <br /> TOTAL DEPTH OF BURING !Feet) ESTIMATED YIELD - (GPM) &TEST TYPE <br /> � <br /> TEST LENGTH (Hrs.)TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL sg" tFeetl 'Alnp nor be represenruti.e ofa=ell'rlort,(;-terve yield. <br /> DEPTH CASING (S) <br /> FROM SURFACE BORE- DEPTH ANNULAR MATERIAL <br /> DIA TYPE <br /> (¢ w FROM SURFACE TYPE <br /> x w a MATERIAL r INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> (Inches) J cc OZ� a GRADE DIAMETER OR WALL IF ANY FILTER PACK <br /> Ft. to Ft. m MENT TONITE FILL <br /> al o LL Onches) THICKNESS (Inches) Ft. to Ft. <br /> 1 sU`f'to v (�) (—') (TYPE-SIZE) <br /> C p I f 3S <br /> ' C rg� .S � ®.020 '1.26.5 <br /> ss s <br /> it x <br /> I a f�i <br /> �s <br /> 1 <br /> , <br /> :1TTIC"MENTS (�) CERTIFICATION STATEMENT <br /> Geologic Log I, the undersigned,certify that this report is complete and accurate to the best of my knowledge °and belief. <br /> �WeiiConstruCion Diagram NAME v Eif/ OR417y/V ,f,f-, "ID�"T�— <br /> _ Geophysical Log(s) (PERSQQN.FIR�_1 M OR CORPORATION) (TYPED R PRINTED) 1 , <br /> _ <br /> Soil/Water Chemical Analyses 3B C �1 nc)n A&0 L4e YI <br /> _ Other ADDRESS CITY STATE l ZIP j <br /> ATTACH ADDITIONAL INFORMATION. IF IT E.YISTS. Signed <br /> WEL DRILLER/UTHORIZED REPRESENTATIVE DATE SIGNED S <br /> 4-55 <br /> uttR n, RE% u.sr. IF ADDITIONAL SPACE IS NEEDED, USE NEXT CONSECUTIVELY NUMBERED FORM <br />