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Y <br /> ORIGINAL STATE OF CALIFORNIA DWRI ONLY — DO No FI N 0 <br /> rA <br /> File with DWR WELL. COMPLETION REPORT <br /> Refer rn TII•ttrll t'tlnll Paliii Alrr. STATE WELL N0./STATION NO. N <br /> Page_of_ T=[I I I I I�❑ <br /> Owner's Well N0. No. L_L <br /> Date Pork Begari tz- ("ILZ Ended (2 Z�22 LAnTiuoE LONGITUDE [J <br /> LouQ Pennii Agencv <br /> APN/TRS/OTHEft <br /> Permit No. I Permit Date <br /> GEOLOGIC LOG V\'EL OWNER z <br /> ORIENTATION ERTICAL _HORIZONTAL __ANGLE (PECIFY) Nume SO V� NSu>r O <br /> DEPTH FROM <br /> M=-TH o lM FLUID lvfdhri g Address � <br /> suRFACE DESCRIPT ON <br /> Describe marer(a7,,groin slzu,color,VIC, Cm star LR <br /> R. Io PL 1YELLILOCATION <br /> 0Address 1z:3 <br /> O <br /> 1 21 Ccaa Se Citv ln <br /> 1 27f GHQ County <br /> 2 55 APN Book <br /> GPage Parcel <br /> 1 o 44.4 Township RangeSection � <br /> I! ( L LAtitue NORTH I Longituclr WEST <br /> z I/ o L7' I DEO. LUN. SEC. HI OEG. MIN. $EC. <br /> 7 LOCATION SKE C ACTIVITY <br /> N ;w_ , Cl( NORTH g NEW WELL <br /> IT (� I YZ I �(� �a�,( MODIFICATION/REPAIR <br /> Oa0Pan <br /> 4 25 _O:h„(SP-0y) <br /> D I L4 0 I Cr1a Sc>~ e a <br /> b (L' y DESTROY(Descl00 <br /> 3 CoA Furooaceerru"GEOLOGIC LC <br /> oa- <br /> ) <br /> O t PLANNED USES(_) <br /> 2 4y <br /> -� WATER SUPPLY <br /> 6 Pubft <br /> (D 400 I [ja.vG JL IMgaacn _InCuatAal <br /> MONITORING <br /> N' <br /> � I TEST W°-LL_ <br /> (DI I CATHODIC PROTECTION_ <br /> CL <br /> HEAT EXCHANGE_ <br /> M <br /> \\/•(�tL DIRECT PUSH_ <br /> —I c INJECTION <br /> < �- �J VAPOR EXTRACTION <br /> 1 <br /> 0 SPAR3ING <br /> I SOUTH <br /> I I IIIIUhYIh•.Pr UenT)br DLtI(Plrr(f lYrtl m arta,Bu)IdluN.r, REMEDIATION <br /> 0 I I Favcra.fJct•rv.1r.and uclarh p ualL tsr addlNnuat a)R'r If OTHER ISPEC;FY) <br /> 11"Lzsanj.PLEASE BE ACCUILITE&CO IPLET�. <br /> y NATER LEVEL&YIELb OF CONIPLETED WELL <br /> I I <br /> _ DEPTH TO FIRST'WATER [FL)I BELOW SURFACE <br /> [D IA <br /> DO DEPTH OF STATIC <br /> _ I I WATER;LEVEL (Fl.)8 D ITE MEASURED <br /> ' ESTIMATED YIELD' (GPM)IS TEST TYP e'\� <br /> p TOTAL DEPTH OF BORING B (Feet) TEST LENGTH (Hm)TOTAL DRAWDOWN (Ft.) <br /> I <br /> (DD TOTAL DEPTH OF COMPLETED WELL �IFeet) •blay!rot be reprantratine ofa well'sVong-rmn yield <br /> � DEPTH ! CASING(5) I, DEPTH <br /> ANNULAR NIATERLAL <br /> BORE- TYPE(_,) FROM SURFACE <br /> FROM SURFACE HOLD TYPE <br /> DIA. w MATERIAL INTERNAL GAUGE SLOT 5122 CbT <br /> eEN: <br /> Pnohn) GRADE DIAMETER OR WALL IF ANY HENCNFTE FILL FILTER PACK <br /> Ff. to Ft. c (Inches) THICKNESS (inches) FL to FL I (TYPE/S2E) <br /> O I ? O ZO <br /> 701 yM 4-1 <br /> I <br /> 0-0 1 1 hK I nso 2o() I -,too <br /> 1 c <br /> ATTACHMENTS(^)! CERTIFICATION STATEMENT W <br /> I,the undersigned,certify that INS report Is complete and accurate to a best of my knowledge and belief, 0 <br /> QeoWQ(alog` j <br /> _.... <br /> W.I.CafWirtlCli0l1' NAME(FEASOR,RRK OR CORPORATION) f1YPED OR PRIMED) W <br /> ' —OeOphystaal LAD�� CTI <br /> i <br /> _.SoWfttsr Chem Anaysea <br /> Other MESS CItt I STATE ZIP <br /> ATTACH ADOFTFONAL/NFl7RA4417 A(Ld f'a!lS7S So d <br /> P I NFll GROIFRIA17HOR17ED RFPR�'.qFNTATIVF WE WINFO C.57 HrIMI,r01MRFR <br />