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Vtllaa Y�I_ \LIi,)AN <br />File with DWR WELL COMPLETION REPORT STATE WELL NO/STATION NO <br />Page Of � y Refer to Instruction Parrtpbler ❑ �, <br />Owner's Well No —1 No 525907 <br />Date Work Began t -z- , Ended <br />2 LAtttuDE LONGITUDE <br />Co (.Ltn P Suv'� - s <br />Local Permit Agency APNvMSiOTHER <br />lift PN <br />D 0 D Permit Date 1 Z 2 9- <br />ermtt o <br />GEOLOGIC LOG <br />CASING(S) <br />TYPE ! <br />WELL OWNER <br />FroCD <br />SLOT SIZE <br />(/�ti <br />,i z MATERIALI <br />o a. <br />ORIENTATION O!L <br />`! <br />± VERTICAL _ HORIZONTAL ^ ANGLE _^ <br />(SPECIFY) <br />Name ` eonov% <br />Rox <br />u '~ GRADE <br />Onchea) THICKNESS <br />(Inches) <br />Ft to Ft <br />DEPTH TO FIRST WAT'ER�(Ft) BELOW SURFACE <br />MSailing Address <br />En, <br />itnq <br />DEPTH FROM <br />SURFACE <br />DE5CRIPTION <br />_ CITY <br />STATE ZIP <br />Ft to Ft <br />d)esmbe material gram» nze, color, etc <br />WELL LOCATION <br />yt 1L4Mq <br />6 <br />Address-AOt <br />WL5t KeiI&P—wI <br />xi, L-ayw- <br />VT7 <br />catty "'w <br />. <br />; 9 0 <br />5: SOL SM oA 1 <br />` l <br />County <br />.0 <br />APN Book Q4 : Page 1 �% <br />Parcel D Z <br />�t (s <br />%Am <br />,rjy,, <br />Township <br />Range <br />Section <br />win <br />� <br />Latitude <br />DEG <br />NORTH <br />MIN SEC <br />Longttude . <br />ES_T_ <br />t WEST <br />DEG MIN SEC <br />—LOCATION SKETCH <br />, CTIVITY (� )— <br />' <br />i <br />' <br />NORTH <br />— NEW WELL <br />1'j, 15 i S <br />L, — <br />' 5 �, 6 <br />w• <br />% <br />r <br />� <br />MCDIFI <br />vow <br />_ <br />t <br />-I,ATIONIREPAIR <br />_Deepen <br />151-1 , a 5 M M�. - o� Je bar <br />I <br />rn <br />__ Other (Specity) <br />i <br />, y1 t V1�L:A � <br />r <br />J <br />� <br />rn <br />rl <br />,�� ! { C L, — Ut �+ �,Lj <br />V <br />� �}YQtj <br />� <br />ZIP_ <br />DESTROY (Descn6e <br />oL `5 <br />t <br />i•O <br />' Sv — 'V <br />VO <br />Procedures and Merenal <br />Unaer GEOLOGICLOG <br />' <br />` <br />Flo` <br />n <br />E1 <br />-V <br />PLANNED USE(S) <br />�{ <br />' Y1tZ 1 G1 �l� <br />•y` <br />3 <br />W <br />Y MONITORING <br />WATER SUPPLY <br />-�e rrc,(," <br />FF ♦rte C �4 '� <br />1� 1 A yt9 f�t� <br />Wow",H WEST Kts�TL���^+ `p 3a <br />L — A `., <br />S [.x.12.4 Gear <br />} SOUTH <br />Illustrate or Descnbe Distance of Well from Landmarks <br />V uh �G such as Roads Buildings Fences Rivera etc <br />ls�PLEASE BE ACCURATE it COMPLETE <br />o GS4d a Svj -I6 t1} ash Down 'irI' <br />TOTAL DEPTH OF BORING 65' O (Feet) <br />TOTAL DEPTH OF COMPLETED WELL -651� (Feet) <br />Domestic <br />Public <br />Irrigation <br />Industrial <br />'TEST WELL <br />CATHODIC PROTEC <br />TION <br />OTHER (Speury) <br />DRILLING �Jr A( �' <br />METHOD FLUID <br />WATER LEVEL b YIE D OF COMPLE ED WELL <br />DEPTH OF STATICqq � "1 <br />WATER LEVEL ��+ Z (Ft) d DATE MEASURED(L! <br />4STIMATED YIELD ` (GPM) b TEST TYPE <br />TEST LENGTH (Hrs) TOTAL DRAWDOWN (Ft ) <br />' May not be represenrauve of a well's long-term yreld <br />DEPTH <br />FROM SURFACE. <br />BORE <br />HOLE <br />CASING(S) <br />TYPE ! <br />INTERNAL GAUGE <br />SLOT SIZE <br />DIA <br />,i z MATERIALI <br />o a. <br />DIAMETER OR WALL <br />IF ANY <br />L <br />(Inches) <br />u '~ GRADE <br />Onchea) THICKNESS <br />(Inches) <br />Ft to Ft <br />m 211 <br />- <br />— <br />DEPTH ANNULAR MATERIAL <br />FROM SURFACE TYPE <br />CE BEN FILTER PACK <br />MENT TONITE FILL <br />Ft to Ft 0! ) (�) (TYPEISIZE) <br />®CE's■�■■�� �!' <br />LEM <br />aviamm <br />NOON <br />a ■0■� <br />■■NONE■■■■■■■■■■■ �■■■■� <br />INN■■O■■vONE!■ri■N■�i■ ■iii <br />.=NEIO <br />ATTAUktYl;Nta (_) <br />_ Geologic Log <br />Well Construction Diagram <br />_ Geophysical Loo(s) <br />SontWeter Chemical Analyses <br />Other <br />I, the undersigned, certify that this reportIs complete and accurate to the best Of my knowledge and belief <br />NAME L R — RYAN V Mfr <br />(PERSON FIRM OR CORPUPATION) (TYPED OR PRINTED) t r �� <br />94-7 . Ip�-o, CSF t Sfc. -G .Dw6LZ C - ��- <br />ArrACH ADDITIONAL, INFORMATION tF rt E)nS73 I I Signed <br />W DRILLER A SHORIZED RE RESENTA <br />DWR 193RFV 796 IF ADDITIONAL SPACE IS NEEDED USE NEXT CONSECUTIVELY <br />riUz <br />y <br />