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TRIPLICATE STATE OF CALIF'ORNiA DWR USE ONLY — DO NOT FILL IN <br /> Owper's Copy4- WELL COMPLETION REPORT <br /> 1 <br /> 1 Refcr to lnstrn Cttr rn Parrlt�Iller STATE WELL NO/STATION NO. <br /> Page_of [I ❑ <br /> Owner's Well No. "° 773924 <br /> Date Work Begain12/14/99 Enders I.2/1 Q/� LATITUDE LONGITUDE <br /> L.oc,.J Penuit Af�l�yw APNITRSIOTHEH <br /> Permit No. `� �! Permit Date LOG WELL OWNER <br /> ORIENTATION X VERTICAL HORIZONTAL _ANGLE (SPEC+Y) NaTne_.Don Har tog Farms, Inc . <br /> DRILLING ROTARY MUD7'497 kilo Rd . <br /> METHOD FLUID <br /> SURFACE M.�ilin Address <br /> DEPTH FROM DESCRIPTION Lod CA 95240 <br /> Ftto Ft Drsc'ribe niaterial, ,grain si;e, Color, etc. CSTY WELL LOCATION STATE ZIP <br /> . <br /> Address. 7497 K i.1 a Rd <br /> C)3 C lay City <br /> 93 107 lisihi Shale County San JC nguin <br /> I IFine SandAPN Book Page Parcel <br /> I ' Rlue clay Township Range Section <br /> I iAlue Sand LatitudeC.NORTH l.An�ltllCle I I _WEST <br /> DEG. MIN, SEDEG- MIN. SEC. <br /> 116 IL60 (:lay Rtue LOCATION SKETCH ACTIVITY (.�L) <br /> I NORTH _X NEW WELL <br /> r MODIFICATIONIREPAIR <br /> Deepen <br /> Other(Specify) <br /> I I <br /> DESTROY(Describe <br /> Procedures and Materials <br /> Under"Gii Lii <br /> PLANNED USES i <br /> WATER SUPPLD S'l- - <br /> Domestic uIrc <br /> ti Irrigation Industrial <br /> I I W w MONITORING" <br /> TEST WELL <br /> CATHODIC PROTECTION_ <br /> HEAT EXCHANGE <br /> DIRECT PUSH <br /> INJECTION <br /> i VAPOR EXTRACTION <br /> I I SPARGING <br /> I I SOUTH REMEDIATION <br /> Illuennte or Desctibe Distance of Well frirm Reurds.Hrrihhngs, <br /> Fences,ffivers,etc.rued attach a nmij7i. Use addrfiunrd paper�i( OTHER(SPECIFY) <br /> uenmsanj.PLEASE BE ACCURATE d:COMPLETE. <br /> i 1 <br /> WATER LEVEL & YIELD OF COMPLETED WELL <br /> i <br /> DEPTH TO FIRST WATER (Ft.) BELOW SURFACE <br /> DEPTH OF STATIC <br /> WATER LEVEL 19 (Ft.)&DATE MEASURED <br /> ESTIMATED YIELD ' (GPM) &TEST TYPE <br /> TOTAL DEPTH OF BORING 160 (Feet) TEST LENGTH (Hrs,)TOTAL DRAWDOWN (FLt <br /> TOT1I.. DEPTH OF COMPLETED WELL 120 (FePt) *Miry not be representative,of a well's lan -term yield. <br /> DEPTH BORE- CASING (S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE HOLE TYPE('—') FROM SURFACE TYPE <br /> DIA. Tz aMATERIAL! INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> (Inches) 1_ a GRADE DIAMETER OR WALL IF ANY MENT TONITE FILL FILTER PACK <br /> FI. to Ft. Q LL (Inches) THICKNESS (inches) Ft. to Ft_ (TYPE/SIZE) <br /> 0 too 14 PLA5 IC 160 v 59 x <br /> x .045 54 120 X GRAVEL <br /> r <br /> I I <br /> I I <br /> ATTACHMENTS (zL) CERTIFICATION STATEMENT <br /> Geologic Log I,the undersigned, certify that this report is complete and accurate to the best of my know#edge and belief. <br /> Weil Construction Diagram NAME <br /> (PES N, I R ORA ONl R PRI DI 1 NC <br /> Geophysical Log(s) <br /> ScilNJater Chemical Analyses 1 I Q Albers Rfi moriii a CA 1953 R7 <br /> Other ADDRESS CTTY STATE ZIP <br /> ' <br /> ATTACH ADDITIONAL INFORMATION. IF IT EXISTS. Signed ,� –x,^ 1 ?1?O/C]O <br /> WEI (iR�C I RUTH r ED REPRESENTATIVE OAT�S69 _C"_ 1I BER <br /> DWR Iti,ti OEr- tl-W IF ADDITIONAL SPACE IS NEEDED, USE NEXT CONSECUTIVELY NUMBERED FORM <br />