Laserfiche WebLink
ORIGINAL STATE OF CALIFORNIA N v — N T F I I N <br /> File with DW1R WELL COMPLETION REPORT l 1 o 01j, <br /> M M <br /> Paige 1.F, f Refer to Instruction Parnpbler STATE WELL NO.ISTATION NO. <br /> _ <br /> Owner's Well No. M'W � N�� 4 SIT � 31 El [Ig <br /> Date Work Began. a 17l-1411--—, Ended _ � LATITUDE LONGITUDE <br /> Local Permit AgencySw36,quiz. at t 95'P,rv��ceS <br /> - rrr <br /> Permit No. Permit Date <br /> OTHkR <br /> GEOLOGIC LOG t WELL OWNER <br /> ORIENTATION VERTICAL — HORIZONTAL —ANGLE — (SPECIFY) Name— <br /> DEPTH <br /> ame d�ra i <br /> DEPTH TO FIRST WATER (Ft) BELOW SURFACE M ling AddressI Q I V <br /> DEPTH FROM <br /> SURFACE DESCRIPTION <br /> Ft. to Ft. Describe material,grain size,color,etc. CIN STATE ZIP <br /> WELL LO AT ON <br /> G Address S (ai I <br /> , I <br /> City <br /> Slit County <br /> APN Book Page Parcel I <br /> QtlVf-- brovo11 CLctuv Seim 'I'orvnship flange Section <br /> or <br /> Latitude A I NORTH Longitude I I WEST <br /> ' I .� T DEG. MIN. SEC. DEG. MIN. SEC. ✓ <br /> LOCATION SKETCH ACTIVITY (_) <br /> NORTH NEW WELL <br /> , <br /> MODIFICATION I REPAIR <br /> - _ Deepen <br /> , <br /> —Other(Specify) <br /> , <br /> DESTROY(Describe <br /> Procedures and Materials <br /> Under"GEOLOGIC LOG") <br /> w PLANNED USE(S) <br /> Luj <br /> Lu M(� ) <br /> ' ONITORING 7 <br /> , <br /> , { WATER SUPPLY <br /> s r <br /> _ Domestic <br /> Public <br /> Irrigation <br /> I I Industrial <br /> CofWAIV,1 4WO 810d <br /> "TEST WELL <br /> CATHODIC PROTEC- <br /> SOUTH TION <br /> ' Illustrate or Descrfbe Distance of Well from Landmarks OTHER(Specify) <br /> such as Roads,Buildings,Fences,Rivers,etc. <br /> PLEASE BE ACCURATE & COMPLETE. <br /> DRILLING <br /> METHOD L+ FLUID <br /> WATER LEVEL & YIELD OF COMPLETED WELL <br /> DEPTH WATER 0 STATIC ' (Ft.) & DATE MEASURED 4—Feb-1 7 <br /> I <br /> ESTIMATED YIELD' (GPM) & TEST TYPE <br /> F <br /> AL DEPTH OF BORINGL (Feet) TEST LENGTH (Hrs_) TOTAL DRAWDOWN (Ft.) <br /> AL DEPTH OF COMPLETED WELL (Feet) *May not be representative of a well's long-term yield. <br /> DEPTH <br /> CASING(S) DEPTH ANNULAR MATERIAL FROM SURFACE BORE- <br /> HOLE TYPE FROM SURFACE TYPE <br /> DIA. <br /> INTERNAL GAUGE SLOT SIZE <br /> Y W o a CE- BEN <br /> - <br /> (Inches) _ oz� J GRADE DIAMETER OR WALL IF ANY MENT TONIT <br /> MATERIALI E FILL FILTER PACK <br /> FL to Ft. �� (Inches) THICKNESS (Inches) FL to Ft. (TYPEISIZE) <br /> a vc o D <br /> 6L_ 541, 40 o r asa <br /> X <br /> , <br /> ATTACHMENTS (✓) CERTIFICATION STATEMENT <br /> I,the undersigned, certify that this report is complete and aIC <br /> to th best of my knowledge and belief. <br /> Geologic Log <br /> v C <br /> Well Construction Diagram NAME(PERSON, FIRM, ilfl'CDRPt] _ DN) (TYPED DA PRt fD) <br /> Geophysical Lops) 1 0. BOX 9 Soh AM a 4� 4sYZ� <br /> Soil/Water Chemical Analyses <br /> ADDRESS CITY STATE 11P <br /> Other <br /> ATTACH ADDITIONAL INFORMATION. IF IT EXISTS. Signed -4 <br /> LL DRILLEfl AU7 RIZED REPRESENTATIVE 6 <br /> DATE SIGNED C-5 V 1 3 ER <br /> DWit 188 REV.7-90 IF ADDITIONAL SPACE IS NEEDED, USE NEXT CONSECUTIVELY NUMBERED FORM r S-31 <br />