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ORIGINAL DWR USE ONLY DO NOT FILL SIN
<br /> File with DWR jr (Il
<br /> WELL COMPLETION REPORT F70111 I' 11 / I L 114 I I � ��_
<br /> Page — .4)f__ k 1 Iv flit,It.1, Pnrnl,l,/, STATE WELL NO STATION NO.
<br /> thsntrtiY�ell \o• No. \
<br /> 805283 f � I ' Ell ) 111 r
<br /> LATITUDE LONGITUDE
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<br /> I', Il,tll \ttAPN,rRS.OTHER
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<br /> (3.01FOZIC LOG
<br /> JHIFNTATION , _JF rt'"A• H IZONTAL _ANGLE _,SPf,CIFY,
<br /> DRILLING '
<br /> n
<br /> -N7 I -ihF METHOD FLUID
<br /> DESC PTIO\
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<br /> _ I AP\ Book P<tt;t Parcel
<br /> T(,\c mhip RanL(t St rti(nl 1
<br /> L Latitildt I NORTH I,011ijbIdt I I WEST
<br /> I IDEG. MIN. SEC. DEG. N. SEC.
<br /> 01% 1LOCATION SKETCH iVITY f�)
<br /> Z' '� ✓ V� NORTH NEW WE.L
<br /> 1
<br /> Sri. MODIFICATION,REPAIR
<br /> 7 I 1 Deepen
<br /> — Other lSpecily)
<br /> lit tf DESTROYtOescnoe
<br /> Procedures and Materiels
<br /> Under GEOLOGIC LOG',
<br /> --•�^-�, ' PL%N " D LSES (�)
<br /> WATE UPPLY
<br /> Domestic P�oi.c
<br /> • `� F Imgation Inoustrial
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<br /> 00
<br /> 3 w MONITORING
<br /> TEST WELL_
<br /> _r'-_T
<br /> CATHODIC PROTECTION
<br /> HEAT EXCHANGE
<br /> 1 DIRECT PUSH_
<br /> ~ L t ) L INJECTION
<br /> VAPOR EXTRACTION_
<br /> - --T
<br /> SPARGING
<br /> _T SOUTH
<br /> REMEDIATION
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<br /> F,•u Rir ,, nhd utta(4 a I,, ,. 1 - mltlith-wd ,o N, rl OTHER(SPECIFY)
<br /> PLEASE BE 1CCCRATE '&COAIPLETf.
<br /> — ,–- WATER LEVEL & YIELD OF COMPLETED WELL
<br /> I I
<br /> T DEPTH TO FIRST WATER (Ft.) BELOW SURFACE
<br /> DEPTH OF STATICIN
<br /> WATER LEVEL � (Ft.)&DATE MEASURED
<br /> _ t�L Cp f4 ESTIMATED YIELD ' (GPM) &TEST TYPE
<br /> I,t ILI\(, f r TEST LENGTH (His.)TOTAL DRAWDOWN (Fl.,
<br /> I I I I 1 1 I fl (+1111'1 f I I I I \11 I I E,•t ' Way not Ger07-eventative of,t well, long-temn vitld.
<br /> TH BORE- DEPTH I ( 1S[\L lS1 1.NNLLAR 11ATERIAL
<br /> ��PP
<br /> FRO IN: HOLE TYPE(�I FROM SURFACE TYPE
<br /> —� DIA. s z ¢ i MATERIAL INTERNAL GAUGE SLOT SIZE CE- BEN-
<br /> -�1 ,. w =0 a DIAMETER OR WALL IF ANY FILTER PACK
<br /> yl a GRADE MENT TONITE FILL
<br /> It = '' Ftv) u� j ,Inche,, THICKNESS ranches, Ft. to Ft. (TYPE312E)
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<br /> 1l'T1(HNIFNT v CERTIFICATION STATEMENT
<br /> 1,the undersigned, c rtify tha this repo Is complete and accurate to the best of my knowledge and belief.
<br /> Geo,oyn.Log
<br /> Wm.Construction Diagram NAME �Q��
<br /> (PERSON, FIRM. OR-CORPORATION) (TYPED OR PRINTED)
<br /> _- Ceop.ty„mal Log(sl 1 �
<br /> b.., W iter Cnermcal Analyses ' ” ,`
<br /> 1DnR / s , CITY SFATE (Iv
<br /> Othe� r-. hl r,'
<br /> Alr,t. r,r t/11n, ,pNAl INFJRMATIJN IF IT EXISTS. Signed
<br /> !!E:I DRILLER AUiriORIZED REPRESENTATIVEDATE S 'NED -5' U(ENS' NU'.18ER
<br /> N,, ,,\ IF ADDITIONAL SPACE IS NEEDED, USE NEXT CONSECUTIVELY NUMBERED FORM
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