Laserfiche WebLink
ORIGINAL STATE OF CALIFORNIA DWR USE ONLY — DO NOT FILL IN <br /> File ;rd',«T DWR F1IELI COMPLETION REPORT I ( i I i, ) I L I I ( <br /> Page <br /> Refer to instrnction Pamphlet STATE WELL NO./STATION NO. <br /> 0wrser's Well No._ ,�r, - _ "° 749434 <br /> Date`l'orlc l3e;an Ended <br /> I �a .rFj� LATITUDE LONGITUDE <br /> � ���� , �' <br /> {'l"S <br /> I,ncal Permit A Y n v •.� rt;I.rii�s R y, <br /> U — 4 Y APNITR SIOTkER <br /> Permit No. Permit Date � '� <br /> GEOLOGIC LOG 'WEL OWNER <br /> ORIENTATION (_) ZERTIGAL HORIZONTAL _ANGLE _(SPECIFY) l�S L1T)e 6 "L ~ ` <br /> DRILLING �, 1Vla � gAddres"s- Y Q- <br /> DEPTH <br /> EURFACEM METHOD DESCRIPT ONFLUID <br /> -CITY j STATE ZIP <br /> Ft. to Ft. Describe inateriez I, arain Size, color, etc, /`• '� 'i` <br /> WL -LOCAT ON <br /> - .Address <br /> Sef a16Q. lou <br /> .' <br /> _ Golnity <br /> '' e•� r ABOO Page' Parcel <br /> Towiisliip' Ranbe Section <br /> -Z.;1Lttld(; I I NORTH J,p11ltUd6 I_ I WEST <br /> DEG, MIN. SEC. DEG. MIN, SEC. <br /> LOCATION SKETCH AfiFI4'ITT (�) <br /> NORTH �/ <br /> NEW WELL <br /> i <br /> MODIFICATION/REPAIR <br /> Deepen <br /> Other(Specify) <br /> - DESTROY(Describe <br /> `"- Procedures and Materiels <br /> Under"GEOLOGIC LOG",I <br /> PLANNED USES (zL) <br /> i �...._..•` WATER SUPPLY <br /> Domestic Public <br /> Irrigation Industrial <br /> F- <br /> ' ' 3 w MONITORING <br /> TEST WELL <br /> I I CATHODIC PROTECTION <br /> I t <br /> HEAT EXCHANGE_ <br /> DIRECT PUSH <br /> t t <br /> INJECTION <br /> VAPOR EXTRACTION <br /> SPARGING _ <br /> SOUTH REMEDIATION <br /> IIhrstrate or Describe Distance of WallfromPoods,B,liidinr.r, <br /> Fences,Ri"rz,etc-and atinch a inap. Use additional paper if OTHER(SPECIFY) <br /> necessary.PLEASE BE ACCURATE&COMPLETE. <br /> WATER LEVEL & YIELD OF COMPLETED WELL <br /> I I <br /> 3 i DEPTH TO FIRST WATER (Ft.) BELOW SURFACE <br /> DEPTH OF STATIC <br /> t t WATER LEVEL (FL)&DATE MEASURED <br /> k ESTIMATED YIELD ' (GPM) &TEST TYPE— <br /> TOTAL DEPTH OF BORINC (Ft:c:) a . TEST LENGTH (Hrs.) TOTAL DRAWOCWN (Ft.) <br /> TOTAL DEPTH OF COMPLETED \YELL � lFeet) 'May not be representative of a well's long-tend yield. <br /> DEPTH CASING (S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE BORE- <br /> HOLE TYpE(2f�) FROM SURFACE TYPE <br /> DIA- Y w O a MATERIAL I INTERNAL GAUGE SLOT SIZE CE- BEN <br /> (Inches) a ¢ ov a GRADE DIAMETER OR WALL IF ANY MENT TONITE FILL FILTER PACK <br /> Fl, to FS. m cc c» (Inches) THICKNESS (Inches) Ft. to Ft. (TYPEISIZE:) <br /> 2r <br /> I I <br /> I I <br /> T'IACFIMENTS (.�L) CERTIFICATION STATEMENT <br /> I, the undersigned,certify that this re rt is complete and accurate to the best of my knowledge and belief. <br /> Weoiogic Log l�1 It MMM s L T <br /> ell Construction Diagram NAME, �k �"ElrrirQ�iLN,y�yt�� ,ytb�?111 iR <br /> (PERSON, 1`01, OR CORPORATIM {TYPED OR PRINTED) —� <br /> Geophysical Log(s) -n•� .+. <br /> oilNJater Chemical Analyses S� Q `9 n 6 jI r <br /> •'� & ADDRESS CITY STATE ZIP <br /> OthBr <br /> HTTRCM ADDITIONAL <br /> IN TION', IF IT EXISTS. Signed <br /> WELL DRILLERlAUTKORIZ EPRESENTATIVE DATE SIGNED C-57 LICENSE NUi:DER <br /> DWR 188 IlFt' IF ADDITIONAL SPACE IS NEEDED, USE NEXT CONSECUTIVELY NUMBERED FORM <br />