Laserfiche WebLink
_Ov.mer's COpY r~' WhLL L;VM1Lr;.1.1VN HhrUkEl. l I I I I I._ r I I I I <br /> VV- Rrfn'ro ltrttrucrian Pump/1rr STATE WELL NO.ISTATrON NO'Page 1—of , <br /> Owner's Well No. � No �$��41 � ) <br /> Date Work Began_+��i�;'� �r)(let3 LATITUME LONGrTUDE <br /> L(tcal Permit Agency-ft-11 d1D#4LA&44 wwo Health , PNr I , R <br /> Prrmit Nn. Permit Date <br /> ULOGIC LOC . WELL OWNER <br /> ORIENTATION { I VERTICAL — HOR12ONTAL — ANGLE _,_ (SPECIFY) NaTnr. <br /> Tpoina - B <br /> bE17H TO FIRST WATER.—t [�(M.) BEL(AV SURFACE Mailing A11(1rrss r%29 E.. --o t. <br /> TH FROM DESCRIPTION 'F.+�r•: C11 <br /> SURFACE - �' � _ STATE <br /> �DEP <br /> toFl Dcrr7ibe mareTial•graft}size,Cola,etc. WELL LOCATION <br /> + Addre5S O`/ 9? C Kesd-eir Rod. <br /> 0-2 <br /> County <br /> APN NxIk- Page Parcel <br /> t rprous, <br /> Township Range SectiolT <br /> or <br /> i NORTH L,Ori Tilude_. WEST <br /> DEG. MIN. SEC. <br /> Latitude <br /> , DEG. MIN, SEC. <br /> I.UCATION'' SKETCH ACTIVITY (' ) <br /> NORTH lvr- INEW WELL <br /> i <br /> 4- MODIFICATION rREPAIR <br /> ' - _ <br /> it - �rw � Deepen I <br /> - Other(SpeCIIV) <br /> i <br /> �,�DESTROY(Daacrlbe <br /> 1 50Procndures en6Malerrals <br /> � Unrlar-GEOLOGICLOG") <br /> PLANNED USE(S)- <br /> U) (�) <br /> MONRORING <br /> WATER SUPPLY <br /> 466 Domestic <br /> Public <br /> ra <br /> � �' Inauuriel <br /> 9 .TEST WE4L" <br /> ' - _ CATHODIC PROTEG - <br /> r 9 SOUTH TrDN <br /> tllnxfrafr ar.DrcnJlsr DtstanCC of Zt'r.L1 front Landmarks OTHER(Speedy) <br />} tvch a.s Roads.Ruildinla,Fenrex,Rivers,et[- <br /> PLEASE BE ACCUNAT8 1r COMPLETE, <br /> DRILLING t le <br /> 223 3-%c ar-AvIal METHOD 1Qp11krise FLUID <br /> WATER LEVEL &.Y'IELD OF COMPLETED WELL <br /> 34i- r_1 Ity <br /> DEPTH OF STATIC D EY E L 11TERASED DONE B T <br /> Gm <br /> WATER LEVEL ii T 7)pt.�sVrl wr[ ��K SYSTEMS <br /> r ESTIMATED YIELD• (GPMY >! TEST TY <br /> TOTAL DEPTH.OF 11011ING _5 (.Fart) TEST LENGTH (Hra.) TOTAL DRAWDOWN (Ft.) <br /> TOTAL bE^FII OF Lf0A1I'LF"IFI) WELL_510! (Peri) `Rfay not hr.t-rtnrseruativr»ry ute11's 70t2g-tt7m yield. <br /> DEPTH CAST NG(S) DEPTH ANNULAR MATERIAL. <br /> FROM SURFACE BORE TYPE FROM SURFACE TYPE <br /> HOLE <br /> t, ? INTERNAL GAUGE SLOT SIZE. <br /> I DIA. E •c r MATERIAL! DIAMETER OR WALL IF ANY RN, <br /> BFN FILTER PACK <br /> (inches) E GRADE TOMrFE FILL <br /> Ft. to Ft. H v (inches) TH1GlGNE55 (Inches) FI. to Ft. t } I� ) (7YF'EtSIZE) <br /> X+ <br /> F 21MIE113 [R v <br /> ■ to <br /> ■ <br /> r <br /> ATTACHA CERTIFICATION STATEMENT <br /> � #L'NTS {—) . <br /> I,the undersigned.certify that this report is complete and accurate to the best of my knowledge and belief. <br /> Geologic Loy . <br /> TUC- <br /> Well Construction Diagram - - NAME <br /> 1109117 N <br /> (PE O , FIRK OR G06 IA P 0 P 1 J <br /> Boil f Water Chemical Analyses ~-P ELN DALAV - <br /> AD - ,CRY STATE 21P <br /> Other <br /> s %. <br /> ATTACH-/IDD[T10N.41 IiVFf7AMRTlON. iF!T EJt75TS. 8lOnpd'FFELTl <br /> � R G BER <br /> DWR ISRRF.",40 IF ADDITIONAL.SPACE IS NEEDED, USE NEXT CONSECUTIVELY NUMBERED FORM <br /> r <br /> -------------- ------ M------------- <br />