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with <br /> INAL <br /> FileORIwithST LTC OF CLLIt-OR\({ DWR USE ONLY — DO NOT FILL IN <br /> )le l DWR ELL CO)VIPLETIOv REPORT I E <br /> R'N' "o Trrstilictr m Pronjjhl'fSTATE WELL NO,STATION NO <br /> {l�vtier ti ii'eil YuMW4No � � # � .. -1 _Fl <br /> U' <br /> Date iL 11t,,111 -� Ended j �'' LATITUDE LONGITUDE <br /> . <br /> Lot-Al FL �',enct , <br /> P('I�lllt No G.0 2 6 2 17 PL'I 1TlIt t]LtC_. 5-1 --nl f APNlTRS10TI-IEA <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION (�) Y-VE9TICAL _,iORIZCNT,AL —ANGLE _(SPECIFYs \llMe F'Xxnn Mabel Q-1 � S'nrt�nr - nT� <br /> DRILLING --� <br /> DEPTH FRCIL7 METHOD FLUID Mailing Addtess2�Q.S'_la�Ztnn lid _ <br /> SURFACE DESCRIPTION <br /> Ft to Ft l�Lseit6r matcutrtl ,Ictal tiIzc eulol itr. CITY STATE ZIP <br /> LS f f— Actdiess 1 605 S . E1�LDo a o vStreet <br /> J cam^ <br /> 7 � C>tti ._k��4�1- —. <br /> CDru-tty San Joaquin <br /> LPN Boat, . f 2 7Page 51 Piled � <br /> 1 T—iniship R urge Section <br /> Latitude NORTH Loncitude i - I WEST I <br /> ° I DEG MIN SEC 5 DEG MIN SEC <br /> LOCATION SKETCH A.CTItiITI (� <br /> NORTH NEW WELL <br /> See attached Site plan. MODIFICATIONIREPAiH <br /> _._., Deepen <br /> € I _ Other(Specify) <br /> I , <br /> DESTROY 1Desanbe <br /> Procedures and Materials <br /> I Under GEOLOGIC LOG J <br /> I , <br /> PL-INKED USES (�1 <br /> NATER SUPPLY <br /> ° I _ Dernesitc _ Public <br /> I co f•- _ Irrigation _ Indmrlal <br /> 3: < MONITORING <br /> TEST WELL <br /> I I CATHODIC PROTECTION_ <br /> ' H8AT EXCHANGE <br /> DIRECT PUSH <br /> I r INJECTCN_ <br /> I I <br /> VAPOR EXTRACTION <br /> SPAFGING <br /> € SOLJTH REMEDIATION <br /> 11bwrafcul Dculil�, UisfcuicL i f holt frruii Roarrls B I I'dirrgs <br /> ' I FLReci RfLLI% I,rC ait(I IittaLlt a ma?) L%e fidditional7t!)1eY f OTHER(SPECIFY) <br /> € I <br /> ricL�stnv PLEASE BE ACCURATE G'COAIPLET <br /> i NATER LE`EL & YIELD OF COMPLETED IVELL <br /> € DEPTH TO FIRST WATER (Ft} BELOW SURFACE <br /> € € DEPTH OF STATIC <br /> WATER LEVEL (Ft)&DATE MEASURED <br /> fT)T1I 1)CI CI[ f}( 13f�lif\( ! ESTIMATED YIELD (GPM) & TEST TYPE <br /> `F,etl TEST LENGTH (Hrs) TOTAL DRAWDOWN (Ft) <br /> TOTAI 1)1_'i'TH (W ( 01IPLLTED [k ELL LLi Cc et) Well,lint be I�p)e3eutnttvL Ot ft '..611, "072q-fe1771 field <br /> DEPTH BOREC%.S \G fS} DEPTH aN`UL1R �I�TERIAL <br /> FROM SURFACEHOLE TYPE(2L) FROM SURFACE TYPE <br /> DIA x ¢ 4 MATERIAL i INTERNAL GAUGE SLOT SIZE CE BEN <br /> (Inchasl ¢ w o� a' GRACE DIAMETER OR NALL IF ANY FILTER PACK <br /> F1 to Ft m Ij U (Inchesy THICKNESS Ft to Ft MENT TONITE FILL <br /> m a {Inches) (TYPEISIZE) <br /> i _'5/Y <br /> 3t, 3 <br /> I I <br /> SIP I tat 5 � r� ��-�� <br /> I . <br /> I r I <br /> i 1 iT LCIIif L\I5 {T} CERTIPIC MO%,f 5T ATElIENT <br /> —oiogic Log <br /> I ,he undersigned certify that this report Is cornpfete and accurate ,o the best of my knoWledga and belief <br /> Well Construction Diagram NAME <br /> PERSON rlRfd Viz i.ORPORprION} t(YPEO UR PRINTEf7} <br /> ieoahvsical Lag(sI <br /> — Soibwarar Chemical((Analyses PQ BOX 416 Z S Z e t 011 CA 95641 <br /> ' V_ Other u� ADCREES -7 CITY ;TATE ZIP <br /> `7209Q4 <br /> a�.1C -IDC71TlON4L rNFORNIATION )F fr ti MISTS Signea <br /> j <br /> +E=��& /AUTIIIIIZ£D tEPRESENTATIVE DATE 2NED � , ELENSE 111JMBER <br /> Ittiti i i I I" IF ADDITIONAL SPACE IS (NEEDED USE NETT CCNSECL!TYVEL`f NUMBERED CORM <br />