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Owner`vcopy �.�iLL (CUMYLEI,.iN JKEFUtiT1 _ -,,Ll •L I I I L._I 1 1 I_ - I I <br /> Page-4—of Refw.r. to Instruatti.{o�n Pamphipa STATE WELL�N0.18TATIO�N NO. <br /> Owner's Well No. -t f ry No. V t7-27010 -1 <br /> LATITUDE LONGITUDE <br /> Date trt o!'k Began Ended <br /> I nnai Permit AgexwyI:. I L I' I .. I <br /> 6Fk=10 If ...y - -Y,. r ,+.• APN!TRSrOTHER. . ;..,:,...:....-.., <br /> Permit Na. <br /> c�1 ULOt;IC S.00 \WELL OWNED <br /> ORIENTATION (_) �ERTICAL I10RIZONI'hL -_ANOLG _(3PCCIr10 �:amA! -•�" ,f t ''. <br /> DRILLING li++�' E sr'•�r"v,?'y '�J- —'7' ., ;.... <br /> METHOD Mai1in `AtlElfess, <br /> DEPTH FROM t i FLL110 'a' 4iJr <br /> SURFACE F.S R 1 101- i'; y -"" - _J <br /> 1)escribe rnaterdal, rain 9izo, oUlor,a_tf, i 4 ; TI,to F::] <br /> ,.Ff. WE3 L LOCATION <br /> I I -----•- „•�.- dress `�z 'R'f• r'fs•.r . <br /> _—r _�-__- f �t1r1t1T� i- v�=a� r��•�— - <br /> -� --r -r- >-'Z I t2t�t,�- Btx�k _.Page _YarceL - —_. <br /> ' __ _ < t V+ Tuw>i�lu), + Ranee Sec4on --- <br /> -; r+ r s .1'z r`Olt LL N Tn7)Qg' r 2 I v <br /> LOCA"[ION SKETCIJ ACTIVITY (-J <br /> ----^NORTH— - /FLEW WE:.L - <br /> I I - •.. rno <br /> ,}•- _= <br /> -PAIR. <br /> _�_�•...—rte` � . -- ",i;.:...'1:�:'ti'�"1��-F-t1�'"`'`( <br /> "' Dzen n <br /> —_---- _.. <br /> 'f t DESTROY(Doscr So <br /> Procadurds.aria Marer0j <br /> Under,"GEOL OGIC LOG' <br /> VJ'T=N 1PPI Y. <br /> •�. "— -r I }} _ C n 5t c _ PUD c <br /> MONITORING <br /> . ' ' . .,t'd : TEST'WELL <br /> CATHODIC PROTECTION <br /> 1 I HEAT EXCHANGE <br /> 1 I <br /> •'� DIRECT PUSH- <br /> �it, ;NJECTION <br /> IJ -JAPOH EXTP"ACTION <br /> --t--'-7 .-SOUTH f <br /> ' Nus rate or Describe'Distance of Weld t�Roads Ba4&gs. REMeulArloN _ <br /> .t 1�crtce.r,ltitkrt etc:mud attach a rrupp. rsa addfhoral npor if ..THEN(SPEOJ,Y) <br /> vacessanp PLLASE:BE ACCUaM d C011fpM' <br /> WATER LEVEL & YIELD.OF COMPLETED WtiELI -- - <br /> - DEPTH TO FIRST WATER (F(.)'BELOW SURFACE <br /> t 1 <br /> --'� DEPTH Of STATIC.- <br /> ��.—r. ----- WATER LEVEL (fIJ 6 DATE,MEASURED <br /> ESTIMATED YIELD'—_ .(GPM)&TL ST TYPE <br /> TOTAL DEPTIJ OF BORING 3.� ._t)'cat) TEST LEf4dTfi._ Di s.)70TAL ORA, DCWN__—( ri <br /> TOTAT DEPTtI OF COA{P1.,L'CED Ut'E;1,L - �F'eet) "M nai he re esenrnir e of a vrU's kg-tem' yie41 <br /> DEPTH. <br /> BORE- CASING (.S) p ANNUL,1.R NIAT)!RIAI <br /> Dc TI - <br /> FROM SURFACE HOLE TYPE(=) FROM SURFACE TYPE <br /> DIA, x x S. MATERIALJ' INTERNAL GAUGE SLOT SIZE` CE� ONI <br /> w c FILTER PAGK <br /> Pis) z p S GRAD£ DIAMETER OR WALL. IF ANY ' MEN;TONITL FILL <br /> Ft. to Ft. n d (Indnej THICKNESS !IMhaa) 'Ff it Pv. <br /> 1 A41% <br /> (TYPJSIZE�k <br /> ' '-s.lam- _Z-- - -. " F._ i _ <br /> HX <br /> 7777 <br /> -- <br /> - <br /> ATTACHMENTS C:ERT.IFICATION STAT'EM.ENT-..- . <br /> I,the undersigned,certity that this repoA is Complete and 0CCUrat0 to the best of my,knowiedge and 6ellel <br /> -- Geologic Log <br /> _- <br /> Well Construction Diagram NAME / - <br /> ."_ iP!RD I D�axau�.norcl PY OadPP, <br /> -- Geophysical Log(s) <br /> Soil/Water Chemical An8h;Se5 <br /> fITYY+ I <br /> _ Olhar r ` <br /> ATTACH AtX)Il70NA1 1NFOArNA.TION.1F IT EXISTS. Signed_�. '• r'^ -_ _- �-t y' 7-' J��. '•�;1r-`'" <br /> C•57 LICFli$i.0 WATER WFLI'0,WMAGOP. dA t`,Ed' C Sl L1.1 Ns riUN ek <br /> 6M 1811 111;v.05-03 IF ADDITIONAL.SPACE tS.NEEDED;USE NEXT CONSECUTIVELY NUMBF.RFD FORM - - <br /> oonJeuu9A II!9 LU0JJ £L Z£bOLS L U I (1W J)7_9:0C L Z LZ-LO-60OZ 011,10686111d A)PIN:a1 <br />