Laserfiche WebLink
ORIGINAL STATE OF CALIFORNIA DWR USE ONLY — DO NOT FILL IN <br /> Fi[e vv`th D W R �VELL COMPLETION TION P.ErO T <br /> pgtrg f Of J L3afur to Tltstrrrcfinn Parnphlr:t STATE WELL NO.ISTATiON NO. <br /> O`�bier's 'i'['ell _o._ 1� No. 749436 <br /> Date Work Began ti "D - <br /> L �• E,de,Cl yz LATITUDE LONGI7UDE <br /> Local Permit kzency v i II tf <br /> Pe)-mit Iv O. APN/TRS/OTHEFt <br /> Peri tit Date <br /> GEOLOGIC LOC Ai-E L SSr�'EIi <br /> ORIEN ii ATION (;:) ZVERTICAL _OORIZONTAL —�„ANGLE —(SPECIFY) �Tafjle Z lt ,ap,% <br /> DRILLING f <br /> DEPTH FROM METHOD FLUID iaTli g Add1'es`s, <br /> SURFACE DESCR PTI <br /> O\ i <br /> Ft. to Ft. Des'cribu material, al'ain size, color, CtC. CITY <br /> b t ; J STATE ZIP <br /> 'E LOCATT�N <br /> Addie. f e;s <br /> "Cityti. <br /> .... :: <br /> ` <br /> '.k-PN Book Page Parcel <br /> Toy nsliip Range Section <br /> Latitude NORTH Longitude'_ I I WEST <br /> I i t •� ., DEG. MIN, SEC. DEG. MIN. SEC. <br /> LOCATION SKETCH <br /> 1rITY (z ) --— <br /> NORTH NEW WELL <br /> MODiPICATIONIREPAIR <br /> d.� — Deepen <br /> -, �pI — Ether(Specify) <br /> DESTROY(Describe <br /> Procedures and Materials <br /> Under"GEOLOGIC LOG') <br /> PLANNED USES <br /> WATER SUPPLY <br /> I I Domestic _ Public <br /> Irrigation _ Industrial <br /> ui ca <br /> I 3 3 w MONITORING <br /> TEST WELL <br /> CATHODIC PROTECTION <br /> I HEAT EXCHANGE�,•_ <br /> I DIRECT PUSH <br /> INJECTION <br /> s , <br /> VAPOR EXTRACTION <br /> SPARGING <br /> I SOUTH <br /> Illustrate or Describe Distance of TVe11 itizmt Roars,Blrildinrs REMEDIATION <br /> I I Tease%Riuvr,s,etc,and attach r+ ,IF. Use addrfinnn2 ppaper i)� OTHER(SPECIFY) _ <br /> necdssary. PLEASE BE ACCURATE&CO,lIPLETE, <br /> I I <br /> WATER LEVEL & YIELD OF COMPLETED WELL <br /> I I DEPTH TO FIRST WATER . (Ft.) BELOW SURFACE <br /> DEPTH OF STATIC <br /> WATER LEVEL (Ft.)a DATE MEASURED <br /> ESTIMATED YIELD " (GPM)Z, TEST TYPE <br /> TOTAL DEPTH OF BORINC {Feet) TEST LENGTH (Hrs.)TOTAL DRAWDOWN (FI,) <br /> TOTAL DEPTEI OF COVPLETED WELL ,(Feet) "May not be representative of a well's long-term yield. <br /> DEPTHBORE- CASING (S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE HOLE n pE(' ) FR0M SURFACE I 1 PE <br /> Dik x ,zi, ¢ a MATERIAL•1 INTERNAL GAUGE SLOT SIZE <br /> 'rt. to Ft. [Inches) dr GRADE DIAMETER OR WALL IF ANY CE- BE.N- <br /> MENT TDNSTE PILL FILTER PACK <br /> m �'� <br /> (Inches) THICKNESS (Inches) Ft. to Ft. (TYPFJSiZE) <br /> t�.T it <br /> a- <br /> ------------ <br /> I <br /> t <br /> i <br /> ACHMENTS {T) CERTIFICATION STATEMENT <br /> I, the Undersigned, certify that this r p rt is complete a d accurate to the best of my knowledge and belief. <br /> eDlogic Log <br /> Well Construction Diagmrn NAMEP.g �r�e ! i 3 <br /> Geophysical Log(s) (PERSON, Rfr, OR CORPORATION) (TYPED OR PRINTED) <br /> _ Soil/Water C emica Anaiyses Sc , <br /> �*^ ADDRESS 24P <br /> _-K Other # Jr� CRY g STATE <br /> A7TACi'f A.DgITlONAL lNfiORM TlpN, IF IT EXISTS. Signed �'{ i- �Q, Z ��i <br /> LE DRILLERlAUTHDR! D E RESEMATIVE, DATE SfGNED C-51 U ENS NUMBER <br /> Dti R IRS HEV :1-97 IF ADDITIONAL SPACE IS NEEDED, USE NEXT CONSECUTIVELY NUMBERED FORM <br />