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' ORIGINAL sTATS of CALIFORNIA — o <br /> File with DW♦ll4R WELL COMPLETION REPORT a 1 � E ° �" <br /> Page-,of± Refer to Instruction Pampblet STATE WELL.No.ISTATION NO <br /> ' Owner's Well No, No. r9 5 Ell] <br /> Date Work Began 2- ,Ended Z 472035 LATITUDE LOHGMM <br /> Local Permit Agent 1 r 7 <br /> Permit Na. 8 j 3 Permft Date A <br /> 1% 1 GEOLOGIC LOG — %" .'WELL OWNER <br /> ORIENTATION VERTICAL —HORIZONTAL {—{+ ANGLE (sPEGFY) Name`�' <br /> DEPTH TO FIRST WATERT"(FL)BELOIV SURFACE Mailin Xddte <br /> ' � <br /> 6EPTH FROM '� <br /> (: r} <br /> SURFACE DESCRIPTION E S C iii P T I D N 'Z• CRY � -'�w' srArt: <br /> Ft, to FL Demibe material,grain rite,-f-,etc, Rr <br /> �� +� ; ; <br /> -e„ELL"40CAT DN <br /> ' - 'Address' <br /> r 1 • r + <br /> APN Bonk 5,7—Pagc Parcel <br /> To,vuShip; Range Section <br /> ' r , , , ar, <br /> Lati,tucfr: I L- NORTH Longitude wt:sr <br /> DEO_ MIN. SEC. 11EI:3. MIN. SEC. <br /> ti LOCATION S%ETCHA�8'IIVITY (�) <br /> r •r" ' + �.1 NORTH ]_ <br /> - ' Naw WELL <br /> 01 <br /> `- MODIFICATIONIREPAIR <br /> ' i i �- '.+•,, .� .r" •1_ ` �� —Deepen <br /> ' r kj _._.Other(Speclfy) <br /> - , <br /> t r ,f ` <br /> ' •`' DESTROY(Describe <br /> , „ r '�'E '•,r'" PrcasduresandMaterists <br /> 1lader"OEt]LOfiiC,I.Oa") <br /> PLAN D USE($) <br /> t r (�! <br /> MONITORING <br /> r WATER SUPPLY <br /> — Domestic <br /> , r <br /> Public <br /> 'Trq��I, ____ trri4alfaq <br /> I ern,. <br /> Yr11,J L� { ��if Industrial <br /> �Ve, --rf4�� — TesrwsLt' <br /> r CATHDDIC PRGTEC- <br /> 1 r ^SOUTH TION <br /> ' lNvstrate or Descri&e l7tsl+rnce of Well frorrr LarrdmOM <br /> ER OEn(opacity) <br /> such as Ilocds,Buildings,fences RFaers,etc. <br /> r <br /> PL)AS);BE ACC&it t e6iiPLETE. <br /> r r 17RILL7NG <br /> r METHOD FLUio ' T" <br /> WATER LEVEL b YIE D OF COMPLETENYF L <br /> t t DEPTH OF STATIC <br /> WATER LEVEL(Ft.) & DATE MEASURED <br /> t ) ESTIMATE:I]YIELD' (GPM) &TEST TYPE <br /> TOTAL DEPTH OF BORING Feet) TEST LENGTH (Hrs.) TOTAL DRAWDOWN (FI.) <br /> ' TOTAL DEPTH OF COMPLETED WELL _{Feet) *May riot be Tep7elentative of a well p long-term yield. <br /> ' <br /> DEPTH CASINGS) DEPTH ANNULAR MATERIAL FROM aaRe- <br /> SURFACE HALF TYPE ✓ FROM SURFACE -RPE <br /> INTERNAL GAUGE SLAT SIZE <br /> DIA. w a, MATERIAL! DIAMETER OR WALL IF ANY CE- BEN <br /> Ft. to FI. (Inchee) �$� J GRADE (Inches) THICKNESS (Inches) Ft, to Ft. MENT TEJNITE FILL (TYPP1S1ZE) <br /> 11.01 <br /> ti3 tL r r <br /> r I <br /> e r <br /> r e <br /> ATTACHIMENTS ('') CERTIFICATION STATEMENT <br /> — Geologic Log I,the urtderslgnod,certify that this report is compleie ansa accurate to the beat cf-mn knowiodge and belief. <br /> ' .."_. Wolf Construction Dlsoram NAMF 0--i t <br /> (nnsoll. FIRM. OR CORPORATION) (TYPED OR PR17) <br /> Gaophyslcel Ls4{s) ��' <br /> ,,. Sogtwater Chemical Anstyses -vQ n LU <br /> other <br /> ADDRESS CITY ¢ STATE P <br /> ATTACH ADDITIONAL lNFORMATfON, IF ti 6rf1ST5. Signed <br /> WELD D DTFgfR TED flEPRESENTA1kYE DATE SIGNEb C•57 ICENSE NUMBER <br /> DWR 188 REV t8o IF ADDITIONAL. SPACE 15 NEEDED, USE NEXT CONSECUTIVELY NUMBERED FORM <br />