Laserfiche WebLink
�RIG1��fAL STATE OF CALIFORNIA DWR USE ONLY — DO NOT FILL iN <br /> File with DWR WELL COMPLETION REPORT <br /> Refcr to Ir+sflacttvr, Pa+It1a1t1ct STATE WELL NDlSTATION NO <br /> ,Page T of ElOwner's well No — Q No 729537 <br /> Date Wotk Began <br /> );rifled ! �O LATYTUDE LONGITUDE <br /> 00(.al Pei mit All ncv Son Js `i1- �� APN/TRSIOTHER <br /> 11etlnit No <202-171/ 'etrn)t Date h7116125 <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION (ZL} � VERTICAL -HORIZONTAL -ANGLE -(SPECIFY) Name ' r_ <br /> DRILLING /� <br /> METHOD �/T (VI Mailing AClCltesS <br /> DEPTH FROM DESCR PT ON LI_. SrL�k C/� �" <br /> SURFACE CITY STATE ZIP <br /> Ft to FI Desci tbf, ntatcrud g1 am stye color etc WELL LOCATION <br /> © I I Addres532� ^'- <br /> 1 <br /> I I SCounty S'r a. <br /> APIA( Bonk Page P u u 1 <br /> 2--Z— ; Township Range Section <br /> L 1titude I NORTH Longitude I I wEsr <br /> DEG MIN SEC DEG MIN SEC <br /> LOCATION SKETCH <br /> NORTH NEW WELL <br /> MODIFICATIONIREPAIR <br /> — Deepen <br /> I I — Other(Specify) <br /> 4�v� <br /> i I ✓✓✓ DESTROY(Describe <br /> Procedures and Materials <br /> i Under GEOLOGIC LOG J <br /> PLANNED USES (2L) <br /> f WATER SUPPLY <br /> Domestic Public <br /> i Irrigation Industrial <br /> w a MONITORING — <br /> Lu <br /> TEST WELL <br /> CATHODIC PROTECTION <br /> HEAT EXCHANGE <br /> I r <br /> DIRECT PUSH <br /> INJECTION <br /> i VAPOR EXTRACTION <br /> SPARGING <br /> SOUTH REMEDIATION <br /> I I IIhItl+ufc m Dc solig Dlstr+rtcr ry Will fiom Rowf1 13+r+1<11+rJ;s <br /> ponce% RILbi-t ctc a,rrl attach a null sr arlrl+tunrrrl pr�ap(i if <br /> OTHER(SPECIFY) <br /> cc4ca j PLITASE BF ACCURATE&COMPLETE <br /> WATLR LEVEL & YIELD OF COMPLETED WELL <br /> DEPTH TO FIRST WATER 13 (Ft) BELOW SURFACE <br /> I i <br /> DEPTH OF STATIC <br /> WATER LEVEL (Ft)&DATE MEASURED <br /> ESTIMATED YIELD (GPM) & TEST TYPE <br /> TOTAL DEPTH OF BORIM :?�(F,,O TEST LENGTH (Hrs) TOTAL DRAWDOWN (Ft) <br /> TOTAI DFPTIl OF COMPLETED WELL (poet) "Alay not Ga lepresentartve of a well's long-tern yuId <br /> DEPTH CASING (S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE BORE —) FROM SURFACE TYPE <br /> TYPE( <br /> HOLE ✓w INTERNAL GAUGE SLDT SIZE CE BEN <br /> DIA r w ¢ a MATERIAL! FILTER PACK <br /> (Inches) Z w Z� a GRADE DIAMETER OR WALL IF ANY MENT TOWTE FILL TYPESIZE <br /> Ft to Ft g (Inches) THICKNESS (Inches) Ft to F1 (✓} (_!) ('�) ( ) <br /> m N d <br /> I ' <br /> AMACHNIENTS CERTIFICATION STATEMENT <br /> t the undersigned certify that this report is complete and accurate to the best of my knowledge and belief <br /> ....� Geologic Log r.. /�_ <br /> Well Corstruction Diagram NAME F�� �?'joi <br /> (PERSON FIRM OR CORP RATION) (TYPED OR PRINTED) <br /> — Geophysical Log(s) r.�. 1 <br /> SOII/Water Chemical Analyses CITY STATE ZIP <br /> Other ADDRESS <br /> ATTACH ADDITIONAL WFORMATION IF fT EXJSTS S+gW ILLER/AUTED NEPRESEN7 IVE DATE SIGNED <br /> C 57 LICENSE NUMBER <br /> I R 110, Rl% t 1 97 IF ADDITIONAL SPAC IS NEEDED USE NEXT CONS NUMBERED FORM <br />