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ORIGINAL STATE OF CALIFORNIA DWR USE ONLY DO NOT FILL IN — <br /> He with DWR "I;VELE COMPILIETION REPORT <br /> Page_.I—pf � y Re_p..r to Instnrctioij Pamphlet STATE WELL NO.ISTA71ON NO, <br /> O-tvner's Well 1'oT W"� '�° 74943 3 <br /> Date «7o7-k Began;— ErZded — 'b"$� LATITUDE ❑ LONGITUDE <br /> lft <br /> Local Permit Agency -, 1,94�i <br /> Permit No. Permit Date , AP NITRsroTHEfi <br /> GEOLOGIC LOG 'EI O1frr'ER <br /> CRSENTATION —VERTICAL _HORIZONTAL _ANGLE _(SPECIFY) <br /> DRILLING )A, <br /> DFPTH FROM METHOD N. �-- FLUID ,M <br /> q. <br /> 91 Add ? <br /> SURF <br /> ACE DESCRIPTION '. ., ,.r'L`` <br /> Ft to FL Describe In[aterital, grain .Si..e, CPl0!', etc. . . � "C "�y 'y STATE Zfp <br /> 11'VLL LOCATION <br /> Address 1-36 <br /> Agla') tau <br /> purity" ro;; <br /> N BioOk Prue Parcel <br /> JTown"Ship Range Section <br /> NORTH .011 rittlde WEST <br /> DEG. MIN. SEC. DEG. MEN. SEC. <br /> r. LOCATION SKETCH IVITP (�) — <br /> ' NORTH r✓ <br /> NEW WELL <br /> MODIFICATIONJREPAIR <br /> - _ Deepen <br /> I I ;, °` �, _ �•� Other(Specify) <br /> - t y DESTROY(Describe <br /> Procedures and Materials <br /> Under"GEOLOGIC LOG"J <br /> r._. <br /> PLANNED USES (=L) <br /> WATER SUPPLY <br /> j)emesbc Public <br /> ti urigetion Industrial <br /> w i <br /> ,Q MONITORING,,,•._ <br /> TES7 WELL <br /> CATHODIC PROTECTION— <br /> HEAT EXCHANGE <br /> I I DIRECT PUSH <br /> INJECTION tef <br /> VAPOR EXTRACTION— <br /> I I <br /> I SPARGING_ <br /> SOUTH REMEDIATION_ <br /> Illustrate or Describe Distance of Well rn Roads, Buildings, <br /> 7 I Fences,Rivers,etc.and attach a"I n U.se ndditionnI aper f OTHER(SPECIFY) <br /> necessary.PLEASE BE ACCURATE Cr COAiPLET . <br /> I I <br /> WATER LEVEL & YIELD OF COSIPLETED WELL <br /> DEPTH TO FIRST WATER �(Ft.) BELOW SURFACE <br /> i DEPTH OF STATIC <br /> WATER LEVEL (FL)&DATE MEASURED <br /> ESTIMATED YIELD ' (GPM)& TEST TYPE'___ i <br /> TOTAL DEPTH OF BORING (Feet) `i <br /> TEST LENGTH (Has,) TOTAL DRAWDOWN <br /> TOTAL DEPTH OF COMPLETED WELL (Feet) Map not be representative of a well's long-term),ield. <br /> DEPTH CASING (S)- DEPTH ANNULARAIATERIAL <br /> FRAM SURFACE BOE TYPE(�} FROM SURFACE <br /> DIA. x w a MATERIAL! INTERNAL GAUGE SLOT SIZE TYPE <br /> (Inches) i w moo~ a GRADE DIAMETER OR WALL IF ANY CE- 6EN <br /> 5 MENT TONITE FILL FILTER PACK <br /> Fi. to rt. m 3= W (Inches) THICKNESS (Inches) Ft. to R. (T(PE/SIZE} <br /> (_ (_) tom) <br /> ' � r5Z <br /> ew c <br /> I <br /> I , <br /> IACII�IE\TS (�j CERTIFICATION' STATE,XIE'�T <br /> iT I, the undersigned, certify that this report is complete and accurate to the best of my knowledge and belief. <br /> �eo�ogic Log Q� { (F�q <br /> LeTYt'1V811 Construction Diagram NAME JL��h � INN 6t� 3i <br /> — Geophysical Log(s) (PERSON, FIRtA,OR CGRPORATMN) (TYPED OR PRINTED) .t..�.zr'. <br /> SoiUWaler Chergical Analyses <br /> ADDRES CITY <br /> Othe - STATE 1 ZIP <br /> + 1 <br /> A7"raCN RDJfI-TONAL 1NFDAMATIOI�r, 1F f7 tXl,$TS� SrgneSA, � �`� p} <br /> WELL DRILIE HIM-IF" <br /> REPRESENTATIVE DATE SIGNED C-57 LICENSE NUMBER <br /> 9WI1 ISS ATV II-D- IF ADDITIONAL SPACE IS NEEDED, USE NEXT CONSECUTIVELY NUMBERED FORM <br />