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- ORIGINAL STATE OF CALIFORNIA <br /> FA vwlth DWR WELL COMPLETION REPORT <br /> Page.-of-4— Refer CO d79tt7u¢1raa Pvmpbler j STATE WELL NO ISTATIo"do <br /> Zner's Well No ���-, NO- 52714122 �-�--'� <br /> Date Work Began�,I , Ended....1Q <br /> 291/477- LATITUDE LONGITUDE <br /> Local Permit Agency I I ► I .1. L_f�! <br /> Permit No Permit Date <br /> / GEOLOGIC LOG WELL 9WNER <br /> ORIENTATION (4) __ 1ER1l1CAL —rg tOWAI_ — ANGLE MPFC") Nam, r A.-4 <br /> ' <br /> DEPTH FROM <br /> DEPTH TO FIRST W4TER (FL) BELOW SURFACE Mailing Address 1#714'-__5.40 �_-f 4120C- - - —- <br /> SURFACE DESCRIPTION CQea�L�/� - -t:X--_�:SQQA <br /> Ft to FI Dewnbe huttenal gram size,ardor etc �� T'— STATE ZIP <br /> WELL LOC 1TION <br /> 'kddress 151 'fie,t'fi /Ow"A 5A.— <br /> ' r 0C Ctty mda&4 Arrest -_ <br /> r � _ County -- - - - - - - - - - - - <br /> APIN Book I f Page-!Wd- Parcel r _ <br /> xo <br /> g To wnor ship lunge Sechon - - <br /> !CL LatitudeRTH Longitude ' <br /> DEG WN SEA DEG MRV SEC <br /> LOCATION SKETCH /ACTIVITY {f } <br /> ' t NOi�TH JG_NEw WELL <br /> ' <br /> MODIFICATIONiREPMR <br /> - _ <br /> DeaPBA <br /> Other(Spaady) <br /> DESTROYrondAfte <br /> ProGedurea and AMtpna <br /> Vader OEOLOGICLOO <br /> Fn PL%XNED USES) <br /> {✓} <br /> 3: MONITORING <br /> WATER SUPPLY <br /> i <br /> _ !JOTdShC <br /> Ifrrgg <br /> wags <br /> _ llCr <br /> ,: lndustrtial <br /> r TEST WVU <br /> A -- CATHOMC PROTEC <br /> --SOUTH ---- MN <br /> —r-- —�� Illwtrate or DLse-rxbe Distance of Well jrom LandrrairL OTHER(5per-s1yl <br /> such as Roads Buildings Fence% Rivers etc <br /> �— —— PLEASE BE ACCURATE Lr COMPLETE <br /> DRILLING <br /> METHOD �Af►y -FLUID <br /> WATER LEFEL 5 YIELI3 F COWPI F1 FD tiiFLL <br /> DEPTH OF STATi5,,, f <br /> WATER LEVEL (Ft) S DATE MEASURED <br /> ESTIMATED YIELD' (GPM) & TEST TYPE <br /> TOTAL DEPTH OF BORING .-��-.(Feet) I TEST LENGTH —_ (Hrs) TOTAL DRAWDOWN (Ft) <br /> TO FAL DEPTH OF t,OMPL.ETFD WP LL (Feet) ' 'Nay not be representanze of a wellT long-term yield <br /> ' DEPTH I I CA,SINC(S) DEPTH AUYt'L 1R M ITERIAL <br /> FROM SURFACI ITY,'�PE7FRAM 5LIRFACE �� TYPEHOLEINTERNAL GAUGE iSLOT SIZE DIA a MATERIAL DIAMETER OR WALL i 1F ANY � - T`` G;< SEN �pnchesy x� ILTER PACK <br /> oc., GRAUE MINT T(3Nt7f FILLFt to Fi uQ (Inehes) THICKNESS onahesy Ft to Ft (TYPE SIZE) <br /> r d <br /> ' ITT ;CH41� Tn ( f 1 -- _ CERTIFICATION ST1TElt]ENT <br /> the undersigned certify th aLthiS report is Complete and accwate!o the best Of my Knawiedge n=i(f belief <br /> Geoioyic Lc4r /'r- L <br /> Wstl COnslni tot0s Lrayrarn NAME 4N ` 5j, /J <br /> Al �� -Kd— <br /> ' (PERSON FIRM OR CORPOPA K) ;TYPED OR ) T <br /> _ lieophyslcal Log(31 <br /> �w Soils Water ehemwall,Analvaee �� <br /> �6slfer?J� Li'[/1J AOMSS 41 CITY 1 SYATE ZIP <br /> V' ATTACH ADDI770NA1 fNFORfAATION JF 1T EXIS7s signed w �. <br /> A ED C 57 t10ENSE 111ilIIBER <br /> JWftISSREV 7eo IF ADDITIONAL gPArF IC mics=nrn trac .r�� ^^••^�^^ <br />