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ueptn trom burrace-mvritss_pra.pat http:rrcetvw. ter - -- v <br /> •File Original with DWR State of California _DWR Use Only-Qo Not Fill In <br /> Well Completion Report - _._ _ __.. i - ; -- 11-7 <br /> Page ( of I Peter to insenre on Pamphlet <br /> State Well Number/Site Number _ <br /> Owner's Well Number I+LW -l9 No. I IN ' °V_ <br /> Date Work Began 3 -1/p 13 Dale Work Ended 3.Zo. /'j Latitude _ Lon igrude__ <br /> Local Permit Agency CzxW7' £AlU+:ur+rq v'hl7K t- NLv7-Lria Acs'%- ---- !. -_ . ; .1- E_ __.I_!.. <br /> Permit Number (����Z Permit Date 3—/y-l 3 APN/TRS/Other <br /> Geolo is Lo Well Owner <br /> 1"c- <br /> Orientation al Horizontal Angle SpecifyName 6 Lt,"A/ S'.-A,r(5 90 -b,NGS bvc, <br /> Drilling Method p'i RV(>&A- Drilling Fluid Mailing Addrei LBB- F7acrie-06-Y/ 1356 <br /> Depth from Surface Description <br /> Feet to Feet Describe material,grain size color,etc Cit DAfaLA'5 Slate ri' zip <br /> _ corvc - - OCL ox Well Location <br /> L0.a,+ D '5,111 Address (%G`( t'dS'r C,,`1AATZ-(L WfrY <br /> City .S rm<T-oA/ County SAr r SOA QvrAJ <br /> Latitude N Longitude IN <br /> Q'r��C 1 r,vA-l_ �jelie`✓Ides Dea. Min Sec Dea, Min. Sec. <br /> Datum Decimal Lat.21 L254"1,$tb Decimal Long.637-411 <br /> pr'gr Pvt. +b1L.nL. CPs,fe, APN Book Page Parcel <br /> Township Range Section <br /> Location Sketch Activit <br /> (Sketch must ter drawn by hares after lamsprinted.) New Well <br /> ' North Modification/Repair <br /> Deepen <br /> iir+ Other <br /> ip,�v! {0 � CDestrap) <br /> �qlE .rl. tuft', �arexeor»o i nam mma,als�,(tr a,m,-GEOLOGIC roc• <br /> otd <br /> Planned Uses <br /> Q f.;l Gds Water Supply <br /> y _ Domestic Public <br /> w Irrigation Industrial <br /> 'Ft`TL3 Cathodic Protection <br /> WGu 3cellt,ti 1,..171,2 CR Dewatering <br /> I y8r ro I t ZG5 Heat Exchange <br /> Injection <br /> Monitoring <br /> Remediation <br /> Sparging <br /> South Test Well <br /> Lonr7-vn/7 L�tvG E LdxILv p Vapor Extraction <br /> In,umm of a d.rao distance orv,on can maaz.Mm.tomos <br /> 7 OVv L/LlarvG V/r<l 16'r Ao6e+L , :rm.s"e anamam,p usa xrw�,io�aiawa,�l msaos,,.r Other <br /> Pleen aeamraoaM com talo <br /> Gem dMr n PRulFr�r_oo wt vf/ afar Level and Yield of Completed Well <br /> Soil TV /ngrat oE. Depth to first water (Feet below surface) <br /> Depth to Static <br /> Water Level (Feet) Date Measured <br /> Total Depth of Boring Feet g'GS Estimated Yield• (GPM) Test Type <br /> Total Depth of Completed WellFeet gE 5 Test Length (Hours) Total Drawdown (Feet) <br /> *May not be representative or a well's long term yield. <br /> Casings Annular Material <br /> Depth from Borehole Type Material Well Outside Screen Slot Size Depth from <br /> Surface Diameter Thickness Diameter Type if Any Surface Fill Description <br /> Feel to Feet Inches Inches Inches (Inches) Feel Io Feet <br /> Attachments Certification Statement <br /> Geologic Log I,the undersigned,certify that this report is complete and accurate to the best of my knowledge and belief <br /> Well Construction Diagram Name Ar4bae'"h) TtP,cY+ %Ni ScV44t 611 Iry L, <br /> Person.Fam of Corporation <br /> Geophysical Log(s) <br /> SoiVWater Chemical Analyses Admens 397$ px+s'xiQie Ave` SIZ 16D C1ry pct A6AJl. "n-ra, t¢ �" zip <br /> Other Signed 1,9Tpt p,r I•.(.. l <br /> ID�'nlatltlilional inrartnallon.sit¢xlsR. D S1 Llce d water wets t n'o'r " Dae S( ned 57 License Nt4f14t#3 1:05 Pi 4 <br /> DWR ISS REV 1MMS IF ADDITIONAL SPACE IS NEEDED.USE NEXT CONSECUTIVELY NUMBERED FORM <br />