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J 1 111 ill 1 LI - II Q11 I L <br />VnAL71iYti— <br />File with DWR WELL COMPLETION REPORT I STATE WELL NO lSTAPON NO <br />Page � °� —4--Refcr to lnstrutrton Pamphlet111 ❑ ❑ <br />11111 1 <br />Owner's Well No M�"u _ �J y "° 525909 <br />I aZ.. f , Ended " F � r LATITUDE LONGITUDE <br />Date Work Began S lA ty eq -1A ca! f Cc% <br />Local Permit Agend f 1231 PNI <br />0 Permit No qs <br />O ClI� Permit Date �T-a <br />GEOLOGIC LOG ELL OWNER <br />� ,� ro Co <br />ORIENTATION (!) VERTICAL _ HORIZONTAL - ANGLE �^ (SPECIFY) Name — ,r1 L3—{st <br />I <br />DEPTH TO FIRST' WATER (FL) BELOW SURFACE sling Address ��L.����� <br />DEPTH FROM DESCRIPTION <br />Q'V7 �Vn <br />SURFACECITY STATE ZIP <br />Ft to Ft Describe maternal, ain size, color, est WELL �J,� LOCATION� �y <br />j W irWJ Address 304 W Ps VeA� Lp 1A/lQ1 id L4AA.e <br />City .�? <br />12.1:7, rAi ML — ll Caunty <br />VtLLO' APN Book _12Lt'S-- Page i n Parcel <br />rOwh Township Range Section <br />1 t'tQwv% Latitude NORTH Longitude + + WEST <br />1S.0 + 15a DEG MIN SEC DEG Mlfl SEC <br />�7t- K " � LOCATION SKETCHljCTIVITY (iL )— <br />NORTH � NEW WELL <br />MLMODIFICATION/REPAIR <br />L r' 1 _ __ Deepen <br />I I a IIT ` Other (SpeelfY) <br />+ Y ' <br />: r yt►s <br />I I <br />47 Irl —^ DESTROY (Descrrbe <br />Procedures and Matenafs <br />� Under GEOLOGICLCG <br />7�_ PLANNED USE(S) <br />2 I� W^ J �t fob a � W MONrrORING <br />��.--Opp 0 ��'1 I 1,II "V WATER SUPPLY <br />•5, 's• r 5 MI 1.ii I < — Domestic <br />J f Public <br />a o <br />t7 <br />Ys7g_ Imgauan <br />W - 1rCe� e. vr1 a� lr at.. e. _ Induatr+al <br />TEST WELL <br />+ + S,: o it � � ��' CATHODIC PROTEC <br />SOUTH TION <br />Mustrote or Describe Distance of Well from Landmarks OTHER (Specity) <br />such as Roads Sutldings Fences Rivers etc <br />+ <br />PLEASE BE ACCURATE lr Cs <br />1 + <br />+ <br />TOTAL DEPTH OF BORING b.r+t (Feet) <br />TOTAL DEPTH OF COMPLETED WELL � (Feet) <br />DRILLING N ft <br />METHOD FLUID <br />WATER LEVEL h YIELD F COMPLETE6 WELL <br />DEPTH OF STATIC <br />WATER LEVEL (Ft) d DATE MEASURED <br />ESTIMATED YIELD (GPM) d TEST TYPE <br />TEST LENGTH (Hra) TOTAL DRAWDOWN (FI) <br />e May not be representative of a well's long -terra yield <br />DEPTH <br />FROM SURFACE <br />BORE <br />HOLE <br />CASING(S) <br />TYPE <br />INTERNAL <br />GAUGE <br />SLOT SIZE <br />DIA <br />,� W g a <br />z <br />MATERIAL/ <br />GRADE <br />DIAMETER <br />OR WALL <br />IF ANY <br />(inches) <br />pnchaa) <br />THICKNESS <br />gnchea) <br />Ft t0 Ft <br />y <br />//�� <br />�/ + V <br />(rye <br />f! <br />Y V <br />2�, <br />�O_ <br />ATTAG1iMLni3 (-) <br />Gealogia Log <br />_ wen Construction Diagram <br />Geophys" Loge) - <br />_ SolltweterChemical Anaiyeea <br />Other <br />DEPTH <br />FROM SURFACE <br />ANNULAR MATERIAL <br />TYPE <br />FILTER PACK <br />(TYPEISIZE) <br />I <br />CE BEN <br />Ft to pt MENT TONITE FILL <br />0� <br />fI� <br />[e - <br />a <br />1, the undersigned, certify that this report Its complete and accurate to the best of my knowledge and beilef <br />rzE7rrLE:P_- RYAN <br />NAME (PERSON FIRM. OR CORMRATIOIII) (ITMO OR rR ED) <br />ATTACH ADDMONAL lNFORMAT)OM !F if EXISTS SlQnad <br />W DRILLER ADTItORIIED REPItE <br />DWR 188 REV 790 IF ADDITIONAL SPACE IS NEEDED USE NEXT <br />Y NUMBERED FORM <br />