Laserfiche WebLink
r! ORIQLNAL STATE OF CALIFORNIA DWR USE ONLY -- DO NOT FILL IN <br /> File with DWR• WELL COMPLETION REPORT <br /> WELL NOISTATION NO <br /> STATE WE <br /> Page_of <br /> Refer to lnsfraclu>ri Prr+ultlrlc[ El ❑ <br /> Owner's Well No A-(Al I- / No 729535 <br /> Date ` oik Began ZOO? Ended 2zKl _ LATITUDE LONGITUDE <br /> Local Pel nett Agency r v <br /> PPlllltt NO 432-No Pell7Trt 1?<lte., 6/ APNITRS/OTHER <br /> GEOLOGIC LOC WELL OWNER <br /> ONFNTATION {✓ ) VERTICAL —HORIZONTAL —ANGLE —(SPECIFY) N tint, <br /> DFIILLING,�[ �latli nur Ali4Es -5s r r� <br /> DEPTH FROM METHOD/��/Owl"FLUID � -5 F13 <br /> �� FI <br /> SURFACE DESCRIPTIOY <br /> FI to Ft DeSLrl1)e matcrial ig)aln st�c rolol Ltr CITY STATE ZfP <br /> G Address 32So G�ELL LOCATION <br /> clil <br /> Cl <br /> 2-5 APN Boot. Page Pafccl <br /> Township Range Seaton <br /> ' Latitude I, I NORTH Longitude I I WEST <br /> DEG MIN SEC DEG MIN SEC <br /> LOCATION SKETCH ACTIIIT] (.:L) <br /> I i NORTH i WELL <br /> MODIFICATION/REPAIR <br /> Deepen <br /> .� Other(Specify) <br /> � I <br /> DESTROY(Describe <br /> Procedures and Marginals <br /> Under GEOLOGIC LOG <br /> PLANNED USES (-' ) <br /> I i WATER SUPPLY <br /> I I � ;�-F LP ______ Domestic Public <br /> Irrigation Industnai <br /> rn ~ <br /> LLI w MONITORING _ <br /> I TEST WELL <br /> i I CATHODIC PROTECTION <br /> HEAT EXCHANGE <br /> DIRECT PUSH <br /> INJECTION <br /> VAPOR EXTRACTION <br /> I I SPARGING <br /> SOUTH REMEDIATION <br /> fllastiatc on D(sc+rbr Distrruc of Bill{rn++i Roads Blideluins <br /> ponces Rii u s dir and atttuh a iwjr a addil ward il rf OTHER{SPECIFY} <br /> rrcccssrlry PLEASE BE ACCURATE dr COMPLETL <br /> WATER LEVEL & YIELD OF COMPLLTED WELL <br /> � I <br /> DEPTH TO FIRST WATER 13. S (Ft) BELOW SURFACE <br /> I i DEPTH OF STATIC <br /> WATER LEVEL (Ft)&DATE MEASURED <br /> ESTIMATED YIELD (GPM) & TEST TYPE <br /> TOTAL DEPTH OF BORING 2-5 (Feet) TEST LENGTH (Hrs) TOTAL DRAWDOWN (R) <br /> TOTAL DEPTH OF COMPI LTED WELL _-2.iEet) 'May not he rep esentative of a veli long-te"n yteld <br /> DEPTH CASING (S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE BORE FROM SURFACE TYPE <br /> }SOLE TYPE(z-) <br /> DIA 5c z ¢ a MATERIAL! INTERNAL GAUGE SLOT SIZE CE BEN <br /> (Inches) w oR a GRADE DIAMETER 4R WALL IF ANY FILTER PACK <br /> F[ to F! �� Fr Fa F! MENT TONITE FILL (TYPE/SIZE <br /> m N c�� - (Inches) THICKNESS (Inches) {�) ( ✓ ) { } ) <br /> YZ- <br /> 44#IT �✓L 2 6 G G <br /> L Y f,? <br /> .o <br /> I i <br /> ATTACHMENTS (:) CERTIFICATION STATEMENT <br /> I, the undersigned certify that this report Is complete and accurate to the best of my knowledge and belief <br /> Geologic Log <br /> 'Well Construction Diagram NAME M.t r a.,r r.lZ. ii <br /> (PERSON FIRM OR CORPORATION) (TYPED OR PRINTED) <br /> — Geophysical Log(s) <br /> — Sail/Water Chemical Analyses �-2 r� ("" yy _, <br /> — Other ADDRESS CITY STATE e1CZIP <br /> ATTACH ADDITIONAL INFORMATION IF IT EXISTS S'42 <br /> of-//-4)J - S s 7 /� <br /> WELL iLLER/AUTHORIZED REPRESENTATIVE DATE SIGNED C 57 LICENSE NUM6ER <br /> nsl It Inti RPs I 1 47 IF ADDITIONAL S RCE IS NEEDED USE NEXT CONSECU`T_j_V_fft4 NUMBERED FORM i <br /> I <br /> I <br />