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MHN I ECR PU LIC WC RI.S 209 239 8495 P 04/04 <br /> 1 rile L11r/IL L G <br /> M Owner's Copy 'FLL CO PLEVION REFOR7 _ I_L _L_LL <br /> lirfer f Jimnrcr .❑r Ydrn111rlot STATE WELL NO LION NO <br /> Owners Well No.- . .. N� ���i +� LATITUDE L 01 SDE <br /> :1j 11 <br /> Date Wort Ragan , Ended i.V � I l _ - <br /> Local Permit Agc Itcy t.. _ ,, 1... 1 I I I I <br /> Pc1Ina Nro021 ? Q..W��. w I'-r)nit Date S4 APNrTRSrDTrtER <br /> CE01 COG[( LOG — �--� 11fFTL OWNrR ^--W <br /> ORIENTATION —VERTICAL _..__..HOpIZONTAL _ANGLE _(spm-y N L111( <br /> DRILLING <br /> dEPFRAM METHOD FLUID t Mailing Ac1d,e55 <br /> TH <br /> GV*ACE DESCRIPTION .. ._,�,. . <br /> FI >d f l 1)L q)01e )Plot(l rnl €!rullt 4+_r cv7 vr, elt CITY STATE IP <br /> -�—r— - DELL LWA110\--- <br /> r r _ Address <br /> counq <br /> APN BookPngc, P.f1(LI _. <br /> U)ng tilde WEST <br /> ! I DE6 MIN SEC DED MIN SEC <br /> `—r— LC1W110N SKETCH ACT11171 (�) <br /> r NORTH NEW WELL <br /> MODEFICATIONPREPAlH <br /> 1 t �. deepen <br /> Other($pacrly) <br /> P i <br /> r c <br /> ,.,.,. bkaTriOY(Doccrfho <br /> r <br /> - Pmeaauras and Ate rarwls <br /> ,. {!Haar 6EUL6111C COG) <br /> T--r— <br /> ' PL ITNEJD USM (t) <br /> r WATER SUPPLY <br /> Dwn ti t-6 _ I$hl l r <br /> IulQAlrph — Inju,MW <br /> I I � � MUNI7DHINt,�. <br /> 1 I TFE1 WLLL <br /> CATHODIC PROTECTION <br /> / 1 I HAAT FXGHANtrE _ <br /> 006CT PUSH r_ <br /> 1 I v VAPOn FXTRACTION <br /> I I SPARGINC <br /> SOUTH <br /> r REMF,nIATIpN <br /> lllrnrrare or lhsl rYlx l)I+7dA{r of i1'rll�rnnr Ifuurlr Brn}rhuHa <br /> ! r fiuco RIrEn Plc nrrdwiarlr a nw+ rr edrllvoisol�xr)kl !f OTNBH(SPECIFY)_.._ <br /> - - ••- tntytrrrn1 TLEASF AF ACCURA71R 0 C0AfPLFT@ <br /> I r <br /> WATFR LEVU k YIELD or CONIPI I rFD 111 L1, <br /> � -- DEPTH TO FIRST WATER - - (FI) BELOW SURFACE <br /> i I <br /> r DEP1H OM STATIC <br /> WATER LEVEL -IFI)&DATE MEASURED <br /> I r <br /> ESTIMATED YIELD ' (GPM)& TEST TYPr-- ._. <br /> I)MAI D1111xI ll 01, HOW V, _ . (Fcct) TEST LENGTH --(Hrs) TOTAL DRAWDOWN--(Ft) <br /> TOIAL X1711 (A' COMPI rTFI)11Fl f ___ __(Fiet� May no be vcPPcrcrrrnrier of n well lu)lt h-ylll)lrl(l <br /> DEPTHCASING ( ) DEPTH Ai\ULAN MAILRIAL <br /> BORE <br /> FROM SURFACE HOLE TYPE(r i FROM SUPFALE _ TYPE <br /> DIA x ¢ a MATERIAL/ INTERNA GAU .E SLOT SIZE Cr SEN � - <br /> (Inchr�) �P S GRADE DIAMETE OR iti ILL 1F ANY MENT TONITE FILL FILTER PACK <br /> F1 10 1`1 m S'i o µ (laches) THICKI ESS (InWrca) F1 10 FIiPSGe) <br /> 1 I <br /> y r <br /> . 1 <br /> 1 r <br /> Y -- <br /> r I r <br /> 1 r <br /> ATTA CHti1F\TS C EATIJPILAI10\ STATLbII !\T <br /> Geoksg:r Log I,the undersigned, rtt#y tha' [his report Is complete and aacurala 10 Me beS1 of my knowledge and belloi <br /> �...� � <br /> well CanSlruaRon Diagram A7AAdS O>CCaa, PLIIt1 & Well Sorviec <br /> KRSON FIRM, OR CORPORMILV {TYPED OR PRINTED) <br /> — Gepnr+ys�sxl Logs) <br /> SuMater Cliemlcal Analyses PCy Bax 3778 Yuba Ci t y l CA �,rj„9C13 <br /> OLFy[4r ADOR04 `` CITY M%Tr `•_-''7li�_ <br /> 11, t �lLC4 �f� -- - <br /> ATTACH AtldrClOr✓ni rNFORAZAT1ply IF 1T FN1S'rS ��4iE11 RILLER/Al! HI�Ea ptPt +ERiATIYE DA IG �+'�Wi�--- C i p ` <br /> TDTgL P 04 <br />