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ORIGINAL STATE OF C1t IFOft\IA DWR USE ONLY — DO NOT FILL IN — <br /> File vwth DWR WELL COMPLETION REPORT <br /> Page i a I Rtfir to Instnretion Pain)ahltt STATE WELL NO/STATION NO <br /> O,.►ner's Well No _ MW-2, No 822130 ❑ ❑ <br /> Date Work Began Ended St%W4L LATITUDE LONGITUDE <br /> Local Permit APWTR SIdTHER Agency 0J 0% cnrrr Il'n D, vis,ei� <br /> I <br /> Pe rmit No _ 019 1 Q Pernut Date �n/99_ <br /> GEOLOGIC LOG /� WELL OWNER <br /> ORIENTATION (✓) VERTICAL —HORIZONTAL —ANGLE —(SPECIFY) Name._ - Alar feel _ <br /> DRILLING <br /> DEPTH FROM METHOD FLUID Mailing Address .� �. eOx /LSO y, „ ., <br /> SURFACE DESCRIPTION Ff: sm, - /fZ 7.79!7 <br /> I1 ! <br /> Fs to Ft Describe Irurtcrurl arrrrn srzc colar etc CITY STATE ZIP <br /> i _;?q -7 <br /> 44 11yYD')♦L L LOGATI01 <br /> Address 1 Ser►�. !!� I <br /> Citi` mam <br /> Cnnnt:N,_ GtGOItl� <br /> ' APN Book �a�Page�Pat cc l .00G <br /> Tosviiship bang( Section <br /> I ' ' <br /> Latitude I I NORTH Longitude I I WEST <br /> i DEG MIN SEC DEG MIN SEC <br /> LOCATION SKETCH ACTIVITI (z�) — <br /> 1 <br /> NORTH NEW WELL <br /> MODIFICATION/REPAIR <br /> I a _ Deepen <br /> I r <br /> Other(Speedy) <br /> 27 <br /> —k aced r Y(Describe <br /> `/• Procedures and Materials <br /> Under GEOLOGIC LOG) <br /> ' <br /> PLANNED USES (.2:L) <br /> WATER SUPPLY <br /> Domestic _ Public <br /> 1 I <br /> F t- �,.. Irrigation _ Industrial <br /> I N <br /> ' tLu <br /> 4 MONITORING <br /> 1 *� <br /> TEST WELL.� <br /> I t CATHODIC PROTECTION. <br /> HEAT EXCHANGE <br /> i I 1 DIRECT PUSH _ <br /> INJECTION _ <br /> I I <br /> 1. d_ VAPOR EXTRACTION_ <br /> SPARGING <br /> i t SOUTH REMEDIATION <br /> 1ltn%Irah in IN rah Distunef (if41ttl�nrnr Su«tls Nurtrinhs <br /> I r Fmets linitis tit and attach a limpsr mldlhuunl 7ur)rri rf OTHER(SPECIFY) <br /> rift{swry PLLASL d3L AGC URATL '&COJIPI 1 TL <br /> I I <br /> I 11ATER LE\EL & 11ELD OF COMPLETED HELL <br /> I I <br /> DEPTH TO FIRST WATER (Ft) BELOW SURFACE <br /> i I DEPTH OF STATIC y <br /> WATER LEVEL l (Ft)&DATE MEASURED ..IrJ��/QQ <br /> I I ESTIMATED YIELD (GPM) & TEST TYPE <br /> I TOTAL DEPTH OF BORING (Fcrt) TEST LENGTH (Hrs) TOTAL DRAWDOWN (Ft) <br /> TOTAL DEPTIf OF COMPLETED HELL (Feet) *jllay riot be irpresentattoe Ufa u*cll'r loug-ter�r�yreld <br /> I DEPTH BORE CASI\G (S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE HOLE TYPE(''—') FROM SURFACE TYPE <br /> DIA x iz o n MATERIAL/ INTERNAL GAUGE SLOT SIZE CE BEN <br /> (finches) g w =r a DIAMETER OR WALL IF ANY FILTER PACK <br /> I Ft to Ft ¢ O GRADE y MENT TONITE FILL <br /> m v (Inches) THICKNESS (Inches) Ft to Ft (TYPE/SIZE) <br /> - ( I ) (!: ) (=) <br /> 0,1220 O : 3 <br /> I w J3� r <br /> i ! 3.� <br /> I <br /> I � <br /> ATTACHMENTS CERTICICkTIO\ STATEMENT <br /> I <br /> Geologic Log I, the undersigned certify that this report Is complete and accurate to the best of my knowledge and belief <br /> yr. <br /> Well Construction Diagram NAME Artf <br /> Geophysical Log(S) <br /> (PERSON F OR CORPORATION) (T ED OR PRINTED) <br /> .^ !.� �, { (� <br /> SOI]/Water Chemical Analyses r 3 C� 1 � ✓4,.«L0 CA <br /> Other ADDRESS CITY STATE 1 ZIP <br /> I ATTACH ADDITIONAL INFORMATION IF IT EXISTS Signed a7 ■Q .5;z Y <br /> WELL DRIZIR/41THORIZED REPRESENTATIVE DATEISIGNECY C 51 LICENSE NUMBER <br /> hili ISS HI It )7 IF ADDITIONAL SPACE IS NEEDED USE NEXT CONSECUTIVELY NUMBERED FORM <br />