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ORIGINAL STATE OF G1LIF0R\1k DWR USE ONLY DO NOT FILL IN <br /> — <br /> File with DWRWELL COMPLETION REPORT <br /> a Of� Rt fc+ to l+stint trail Pn+u)i l+h t STATE WELL NO,STATION N6 <br /> P L <br /> v.<ltel ti VI etl NO MW 6 No J / <br /> 1 5 4 0 �/ 1 LATITUDE LONGITUDE <br /> Datc NI m 1. Be,,ndn €; Elided <br /> Loc Pei hilt Oa uin icoilnty Public Health AN'M I KWU I HER <br /> 10 .Pet illit No Q026236 Pet wit D Tte 5—1 —01 <br /> GEOLOGIC LOG AVELL OWNER <br /> ORIENTATION (,�L _VERTICAL —HORIZONTAL —ANGLE _(SPECIFY) Nam, xxonMobZl Olt Corporation <br /> i4[athnQ Address <br /> DRILLING 2300 Clayon Rd. Ste. 1250 <br /> DEPTH FRAM METHOD FLUID <br /> SURFACE DESCRIPTION cTELL LOCATION <br /> (c nCOrd, CA 94520 <br /> neSc i tb( 1+atr ,I tal tir(fill %Izel (Allo) c tc STATE ZIP <br /> Ft to FI <br /> ti, i ►J �-A Addl ESS Center Str(=fnt <br /> CLLZ <br /> Y E 7V Cottnh+ <br /> I o <br /> r kPN Boot._ 1 �Page 1 Parcel <br /> I I Toxvitship Range Section <br /> I I Uititticle I I NORTH Longitude I I _WEST <br /> DEC, MIN SEC DEG MIN SEC <br /> LOCATION SKETCIi JLCTIVITI (!) <br /> I I NORTH NEW WELL <br /> See attached site plan. MODIFICATION/REPAIR <br /> Deepen <br /> I _ Other(Specify) <br /> I I <br /> i X DESTROY(Describe <br /> ProcedureS and Materials <br /> i Under GEOLOGIC LOG J <br /> PLANNED USES (i::.) <br /> WATER SUPPLY <br /> Domestic PLbI1C <br /> Irrigation Industrial <br /> C0 <br /> i I w MONITORING <br /> TEST WELL_ <br /> ! I <br /> CATHODIC PROTECTION <br /> HEAT EXCHANGE— <br /> DIRECT PUSH____ <br /> I I INJECTION — <br /> VAPOR EXTRACTION — <br /> SPARGING_ <br /> SOUTH REMEDIATION _ <br /> I!)astrate or DesurGc Distance of Wdl jlvnl Rnrttls 13ud(1Mg5 <br /> F(nccr RILCYS etc and attach rr+nn l L'si-addltumal gaps r If OTHER{SPECIFY) <br /> utccxsarll PLEASE BE ACCEIRATE:t C031PEET <br /> NATER LEVEL & YIELD OF COMPLETED WELL <br /> I I <br /> DEPTH TO FIRST WATER (Ft) BELOW SURFACE <br /> I I <br /> DEPTH OF STATIC <br /> WATER LEVEL {FI)&DATE MEASURED <br /> ' ESTIMATED YIELD (GPM) & TEST TYPE <br /> TOI11 1)171711 OF BORT\C �IFLet) TEST LENGTH (Hrs) TOTAL DRAWDOWN (Ft) <br /> rot 1L DE17I1 OF COMPLE71'1) `I EL[ uotLe icpreselltcltlLe oju, ell's lorlg-rct711 Weld <br /> DEPTH CASING (5) DEPTH ANNULAII NIATERIAL <br /> FROM SURFACE BORE TYPE() FROM SURFACE TYPE <br /> HOLE : <br /> DIA Y iL a d MATERIAL! INTERNAL GAUGE SLOT SIZE CE SEN <br /> z rZ DIAMETER OR WALL IF ANY MEENT TON17E FILL FILTER PACK <br /> (inches) J GRADE Ft to Ft (TYPE15fZE) <br /> FI to Ft U o LL (Inched 7HIGKNESS (inches) ( r ) (�) ( r ) <br /> S� X vc :2- } '` <br /> I � <br /> I <br /> ITT�C Ii\iI N iS (�) CLRTIFIC kFION 5T ITE\fI NT <br /> I J I the undersigned certify chat this report Is complete and accurate to the best of my knowledge and belief <br /> Geolagtc Log <br /> Well Construction Diagram NAME ti L <br /> (PERSON FIRM UK LORPORATION) (TYPED OR PRINTED) <br /> Geophysical Log(s) ���'�(^� 7�i <br /> SolllWater hemicaj Analyses w ; <br /> ADDRESS CITY STATE ZIP <br /> Other `►a pot <br /> ,ATTACH dDDITlONAL INFORMATION .F !T EJCISTS Sinned DATE GNEO C'7, LECENSE NUMBER <br /> lAUTHORI2FD REPRE ENT LVE <br /> I>stii Ititi I I s it I- IF ADDITIONAL SPACE IS NEEDED USE NEXT CONSECUTIVELY NUMBERED FORM <br />