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,! ow rs opy ELL COMPLEI -JN HEYUK'1"- ___LL!
<br /> Refer to Gtstructicti:IMnphlet STATE WELL NO./STATION NO.
<br /> overs euio. IID. 0927008
<br /> Date Work Began 1 1 , .Ended 4 I l-^< — _LATITUDE LONGITUDE
<br /> r:
<br /> � _ i C—L.�.__1 I l I
<br /> Local Permit;Agency l�. t r A - _ k =�., y ,.
<br /> . .n•,.)'4C�-�T-'r�-L""i . `—r"��:�.z-�.'''--�-�'Tt-I- APN/TR3/OTHER
<br /> 1` 4 d!4z% ----Permit Date
<br /> Permit No.t r_. <_ r
<br /> GEOLOGIC I.00 'W'£LL OWNER
<br /> ORIENTATION { _i VERTK)AL _..__HOfl120NTAL __ANGLE .__-(Srr;CIFY) NiRIY�C4
<br /> RIL
<br /> METHoo.. �Ftula _ n4a111rg Acl�te -
<br /> DEPTRFROM;: ' - . sem, - , - G
<br /> - SURFACE DFSCRIPT�ON F ' L ✓' : -�f
<br /> Uoscr•iGc material, rain size, color, ate, t �? i - SIATL�' ZIP
<br /> Ft. to' R'EI:L Locarra\
<br /> Ar, - -
<br /> �I—r�-�---r'�?t�ttac#•{'c�--was--� -:`,( 's,
<br /> Ity
<br /> IA.—
<br /> PN B 7 Pale Parcel
<br /> ', ; r * 1 '" TDIA IisliiP,s ' Range Section: f
<br /> F.
<br /> c K 5 LOCATION SKETCH 'i4CTIVITY,
<br /> I i ' :.`• _, ' i__y' -� NORTH-- T I:..., DIFICATIOPURc PAIR
<br /> . _--".TT'�� ,,; ,, -•,,CJs - f �-. .t�••. _.-. CseGen
<br /> Orh3r/SperifY)
<br /> Procedures and Usferiers
<br /> I i � 1 r^,, '..,,;..,.•+` _ 4 .Under"GEOLOGIC,L(>G'
<br /> 3 e y+' t 1 nOr.IToizI;J'
<br /> 1 I iw• .. '•. TEST WELL
<br /> CATHOpI;PFOTECTION-
<br /> .u^„r -i_-AT EXCHANGE
<br /> =;
<br /> 0 'J:R=CT F:JSH—_
<br /> _ ItJJEC710N
<br /> VAPOR EXTRA,TION
<br /> 1 I ^i SFArIE1,4G _-_
<br /> —
<br /> SOUTH
<br /> 116strate or 1, lNstnnee uj LY'etT/rnm Noads._Bulidttl:, OTiiR( P IF')
<br /> Fe w a,Aiuera,etc.and,mwh a nmpp.CCao odditional rr ij -
<br /> -_ necmanj.PLEASE BE ACC& TE V(:oAfPLET
<br /> WATER IF1?E.L_&YIELD;OF COMPLI TE1) 15'E1.1,
<br /> —_T DEPTH TO FIRST WATER (1`1)BELOW SURFACC.'
<br /> I I
<br /> r: I DEPTH OF STATIC -
<br /> T-_--�- --- WATER LEVEL (FL)8 DATE MEASURED
<br /> .—. ..__ ESTIMATED YIELD (GPM)'B;rES7 iYFE _------___---- --_
<br /> T(7I:1I;I2EYI'H•OY I3ORfNCzes�k .__1Feat) TEST LF1JGTH (Ilia.) TOTAL OnAWDOWN._ •(F,.)
<br /> TOTAL DEPTI�.QF CONIFLEUD WELL (Feet) *Xfoy rini he rer•esentaEitie of ri ilie!!'s long-tciin yield.
<br /> DEPTH:t` BORE- CASING (S) DEPTit ANNULAR M a1 E_RI11
<br /> FROM,SURFACE HOLE PE( : )_ FROM SURFACE' TYPE
<br /> DIA. x z n MATERIAL i IN I EHNAL GAUGE SLOT S17E ------ CE; BEN. '
<br /> (inches) .f ti GRADE DIAMETER OR WALL IF ANY' MENT T'OWE FILL- FILTER PACK
<br /> Ft. to FIL ¢ � (Indles) THICKNESS (Inches) FI In Ft •'� (TYr'E:S TF)
<br /> r a
<br /> •��^' 7 "_461G,_ J. L +a GE
<br /> I i1
<br /> --- AT-TACHMENTS (::L) CERTIFICATION STATEAWNT
<br /> I,the undersigned,certify that this report is complete and accurate to'the best ofmy*now!edge aria belief.
<br /> _ Geologic Log
<br /> Well Construction Diagram NAME '~ —• - —
<br /> p. St ,FlV T{7d-pT C ? AT N} $BR?P.ItJMD)
<br /> Geophysical Logjs) }'-•.:``:''
<br /> k:
<br /> Soll/Water Gnomical Analyses /ct _; -
<br /> OTE r SfArt
<br /> Other
<br /> ATTACH ADDITIONAL INFORMATION, IF IT EXISTS. B C-37 UCENSEO WATER WEU CONTRAGW f DATE SIGiGNED'•� •- C"_57'LI rMrNtUBIR
<br /> DWR 188 REI.0.5413 IF AODMONAL. SPACE IS.NEEDED, USE NEXT CONSECUTIVF_L:Y NUMSFFIFOr FORM
<br /> loon.reuu0A 1!!a:LU0Jd £1iZ£U0L9I t4 (1v4o)ZS:OvLZ LZ-LO-600Z OL Jo g abed bola:oL
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