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ORIGINAL ST= OF CtLIPOR\l DwR USE ONLY — OO N07 FILL IN <br /> 1=11e with DWR WELL COMPLETION REPORT <br /> La-eof�-- R'I'Ll to IIr'Nlfrtloll J'r7nppid'f <br /> 1 754 �(''ti STATE WELL NO/STATION NO <br /> t.)N lel S k'Vell \o No V I � �u <br /> Dal \[oil, l3e`,,r Cluled �% LATITUDE LONGITUDE <br /> L,,,-,l Pelinit In__t <br /> I_ APNITRSIOTHER <br /> Peimit No 0026237 - -- <br /> _ Pel mit D lte -1 - <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION (�1 X—VERTICAL —HORIZONTAL —ANGLE <br /> _(SPECIFY) va[]le <br /> DRILLING Nlailsng �dclsess 2300 C'1 a tnn Rd - �tP 1250 <br /> DEPTH FROht METHOD FLUID <br /> SURFACE DESCRIPTION {"�(�nc-nrd� C'A 94520 <br /> Ft to Ft lac SCF7lJE ai atc)ial `"1(1101 SIZL COlol otc CITY STATE ZIP <br /> 1 �� ELL LOCA ION <br /> �� "� address 16 0-5-- S! E _ _Dora o Street <br /> I <br /> ' Citi stockon <br /> I <br /> Go,>atr San ,Taag.uinIf CA_ <br /> .. <br /> --Y-� ur e'-�P V Book ]tee 1 P ucel <br /> n Township Range Section <br /> 1—Itztude NORTH Longitude— I_ I WEST <br /> DEG MIN SEC DEG MIN SEC <br /> LOCATION SKETCH -kCTIV[T7 (�) <br /> ' f NORTH — NEW WELL <br /> See attached site plan. MODIFOATIONIREPAIR <br /> I <br /> — Deepen <br /> i — Other(Specli <br /> s A DESTROY(Descrlbe <br /> Procedures and Maianals <br /> Under GEOLOGIC LOG } <br /> PLANNED USES (4) <br /> WATER SUPPLY <br /> i _ Domestic „•„ Public <br /> F _ Irrigauon _•_,_ Industrial <br /> LU is MONITORING <br /> TEST WELL <br /> I i CATHODIC PROTECTION <br /> HEAT EXCHANGE <br /> DIRECT PUSH <br /> I i ' <br /> INJECTION <br /> i I <br /> VAPOR EXTRACTION <br /> SPARGiNG <br /> i SOUTH REMEDIATION <br /> I(lastrntt of Desellbi Uistcnlcc of 1Fc11 fizun Roads Biuldnrvs <br /> I I Rnccs Rlccrr ctc fold atterch a nur) Lec rrrldrtloltal )aper of OTHER(SPECIFY) <br /> mccrsmy PLEASE BE ACCURAL L-COhIPLET <br /> I I <br /> I I <br /> IVAJER LEVEL & YIELD OF COMPLETED WELL <br /> I DEPTH TO FIRST WATER (Ft) BELOW SURFACE <br /> � I <br /> DEPTH OF STATIC <br /> WATER LEVEL (rt)&DATE MEASURED <br /> pp��,,�� ��� ESTIMATED YIELD (GPM) $ TEST TYPE „ <br /> FlDLI1111 (IF 130111\C (Ft(0 TEST LENGTH (Hrs) TOTAL DRAWDOWN (Ft) <br /> I i FDFPTH 4)( ( OMPLFTED 11 ELL (AK (Feet) ' 11Idy not be ieilneutativc of ea -.ell') loncg-ralwi 1'teld <br /> DEPTH BORE CJilIS (S) DEPTH AN\UL4R %IATERINL <br /> FROM SURFACE <br /> HALE Typ@{_} FROM SURFACE TYPE <br /> DIA x �, ¢o d MATERIAL! INTERNAL GAUGE SLOT SIZE CE BEN <br /> (Inches) z w� DIAMETER OR WALL IF ANY FILTER PACK <br /> GRADE MENT TOl FILL <br /> Ft to Pi m '�� 1 (Inches) THICKNESS patties) Ft to Ft (TYPEISIZEI <br /> Nc <br /> go <br /> I <br /> I <br /> I <br /> I <br /> Mk(AIML\rs CERTIFICiTION STITEZ)IENT <br /> Geologic Log I the Undersigned certify that this report Is complete and accurate to the best of my knowledge and belief <br /> Wel.[Canstrw-tion Diagram NAME V & W D,r,i,j,l i ri . <br /> Geophysical Logs) (PERSON rIRM OR CORPORATION) (TYPED 09-Pi <br /> SOIIIWater Chanlil Analyses PO BOX 416 I S l eton CA 95641 <br /> Other ADDRESS ! CITY G / —]STATE ZIP <br /> t 17ACN ADDITIONAL lPJFORMATlON !F iT ErfSTS Srgned ='�J' i�� �� �/ j l 7 2 0 g fl 4 <br /> "�_O!AUTHORIZED REPRESENTATIVE DATE IGN£D L 51 LICENSE NUMBER <br /> Sul Ititi I I tI r IF ADDITIONAL SPACE IS NEEDED USE NEXT CONSECUTIVELY 6)UPIE3ERED FORM <br />