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ORIGINAL STATE OF CALIFORNIA )wR USE ONLY — DO NOT FILL IN <br /> Get newnumber <br /> File with DWR ALL COMPLETION REPORT 'E_ <br /> PageA_of_L_t Rrfcr to Inctnrctinn Pnulllhlrt STATE WELL NO/STATION NO <br /> Owner's Well No. IIYI LA; 1 No. e000452 <br /> Date Work Began j1J%12�S ,4MI Ended_ TOW C2 TUG f I LATITUDE ❑ LONGITUDE <br /> Local Pennit Agency SSC PH S L N <br /> Pen-nit No.NZCC J�b 5 5-U Pennit Date 3y,,- 1 / APN/TRS/OTHER <br /> / GEOLOGIC LOG WELL OWNER <br /> ORIENTATION (:) .jam VERTICAL HORIZONTAL -ANGLE -SPECIFY) Name 6'f e Pa S^1 �/� <br /> DEPTH FROM METHOD ILLINGI t FLUID Mailing Address "" 1 r�(]th <br /> SURFACE DESCRIPTION _YVIOWXTIE L-Q <br /> Ft to Ft Describe material, gain size, color, etc. CITY STATE LP <br /> Cj "� W'LL I,O�ATJ.ON <br /> .� - rtn. rL� Address (G(c �3 L. fW rKK)) <br /> On - r City MC.-AleCCt <br /> 10� CSC 2 = ko VVI, Y' A <br /> C County L� A. � <br /> � CA A�til <br /> 1 APN Bookas5K Page_24K) Parcel <br /> v' to Vr,' Township Range Section <br /> Latitude37 iq:Z 153 NORTH LongitudeLd`t I 10 1-33 WEST <br /> I I DEG. MIN. SEC. DEG MIN. SEC. <br /> LOCATION SKETCH — ACTIVITY (2�) <br /> NORTH <br /> _ NEW WELL <br /> 10( MOD I FICATION/REPAIP. <br /> Deepen <br /> I I _ Other(Specify) <br /> 1 Sc1„r we <br /> I P YI <br /> U. �C \ DESTROY(Describe <br /> I Procedures and Malena/s <br /> Under"GEOLOGIC LOG") <br /> �L IICI1sAL� I PLANNED USES (2!�) <br /> C� WATER SUPPLY <br /> I I <br /> J Domestic Public <br /> ' I NI S r Ongation Industrial <br /> 3 to MONITORING <br /> J TEST WELL <br /> CATHODIC PROTECTION <br /> I ''` HEAT EXCHANGE_ <br /> 1 �> W_ DIRECT PUSH_ <br /> --- INJECTION_ <br /> VAPOR EXTRACTION <br /> SPARGING <br /> SOUTH REMEDIATION <br /> Ilhntratc or Dexcribc Distnncr r'I Well fin Ri.A.Buildings, <br /> I I Feucet,Ricers.etc mill attach a mar Vie arlditiunnl'' A.,if OTHER(SPECIFY) <br /> nenssnry.PLEASE BE ACCURATE&COMPLETE. <br /> WATER LEVEL & YIELD OF COMPLETED WELL <br /> DEPTH TO FIRST WATER 1.5 (Ft.)BELOW SURFACE <br /> DEPTH OF STATIC L !! i <br /> WATER LEVEL )r C) (Ft.)b DATE MEASURED <br /> r ESTIMATED YIELD ' (GPM)6 TEST TYPE <br /> TOTAL DEPTH OF BORING (Feet)�� TEST LENGTH (Firs.)TOTAL DRAWDOWN (FL) <br /> TOTAL DEPTH OF COMPLETED WELL _:t)1!(Feet) ",Nay not be representative ofa mrll's long-term weld. hlv 1e51- <br /> DEPTH BORE- CASING (S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE HOLE TYPE() FROM SURFACE <br /> TYPE <br /> MATERIAL/ INTERNAL GE SLOT SIZE CE- BEN- <br /> Fl. to FI (Inches) g GRADE DIAMETER �R-ALL IF ANV FILTER PACK <br /> MENT TONITE FILL <br /> (Incnes) TESS (Inches) Ff. to FL (TYPE/SIZE) <br /> q r i LL pv It O S <br /> pue, 4t' DI 5 lug14 <br /> I <br /> I , <br /> ATTACHMENTS CERTIFICATION STATEMENT <br /> Geologic Log <br /> I,the undersigned,certify that this report is complete and accurate to the best of my knowledge and belief. <br /> [� <br /> _ Well Construction Diagram NAME tAaQ I ©• Ay,YVAL ic'n �- &,&bC_ - <br /> _ Geophysical Log(s) <br /> (PERSON. FIRM. OR CORPORATION) (TYPED OR PRIMED) <br /> ^1] Ub l aL 0 fl aW�U O <br /> _ Soil/Water Chemical Analyses '�`C^ "�-+ �up LN- LUu <br /> Other <br /> ADDRESS CITY STATE ZIP <br /> �IPISIWAIIIII D62110 <br /> ATTACH ADDITIONAL INFORMATION, lF IT EX/STS. Signed 1 " /0p <br /> WELL LLER7AUATE j9IGNFD C-57 LICENSE N BER <br /> uts'x tvx REV 11 97 IF ADDITIONAL SPACE 11IS NEEDED, USE NEXT CONSECUTIVELY NUMBERED FORM <br />