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I 0wr!prVQppy '\---ZLL COMPLEIx. JN REPOR <br /> Page LiA—L Ilefe, to Instruction Pamphlet STATE WELL NO.ISTATION NO. <br /> Dwncr's'WeH No. No. 0927013 --J <br /> Date Work Bt:vitzi_k Ended_-L <br /> LATITUDE LONGITUDE <br /> Uwal Pprinit Agenry 1 1 1 - I ( 'I I I <br /> APNITSSIOTHES <br /> Permit No ,1z 4:; Permit Date <br /> GEOLOGIC J,OG <br /> OWNER <br /> N,ORIENTATIONz�. _k:::'_vEwncAL 110.Illi6NTAL ANGLt; CSj-eviy) Not. jot <br /> DRILLING <br /> I&A <br /> METHOD'4=1 I +LUID L i <br /> DEPTI-1 FROM. <br /> SURFACE DESCRIPTION <br /> SIT- IP <br /> R, 10 <br /> LOCATION <br /> A10 <br /> q <br /> 7 <br /> V-5 Mok xfd-. <br /> 6=1 x— <br /> A -P I <br /> arce <br /> ---------— J j fl, Section <br /> p N <br /> j <br /> )E <br /> LOCATIO.N.:SKETCII ACTIVITXAZ)i <br /> VNORTH EW <br /> ., <br /> Olhei Spe dity) <br /> ____..—I OGSTAOY <br /> Pmcedures end MirdrJah <br /> Under"GEOLOGICLOG <br /> USES <br /> WATER SUPPLY <br /> Domestic Publlc <br /> lrdpli­. Industria <br /> Mo 1�8ln <br /> TEST WELL <br /> A CAT140DIG PR07F TION <br /> HCAT rXCJIAN(3E-. <br /> INJECTION <br /> VAPOR EXT8AGf10N <br /> SPARGINC <br /> SOUTH <br /> Illustrate or Ds�a Distaws of Wsfl frim Roads.Buikliqs <br /> Fema.itwm;4&! Advadch a map.UscadrUfsond aper0-HER j5PE-_1FY) <br /> Avywary.PLEASE BEACCURATR&COMPLEg <br /> 0 <br /> - WATER LEM -YIELD F COMPLETED <br /> DEPTH TO FIRST WATER (Ft.)BELOW SURFACEP .14 OF STATIC-: <br /> EPT <br /> WATER LEVFL._(FQ&DATE MEASUREW <br /> EsnmArED Yl-,':LD (GPM)& <br /> TOTAL,IjEPTJ I'OIP.bOBING (Fi6t)- 'TEST LENGTH (Mrs,)TOTAL DRAWDOWN (Ft.)', ti <br /> TO-AL: OF COMPLETED' `36v 7,101 iNi representative of well's hng-tet7i -yield. <br /> DEP f H so DEPTH: AN. <br /> CASING (5) ANNULAR MAYERIAL <br /> FROM SURFACE. FROM-SURFACE.TYPE(4) <br /> 'TYPE <br /> DIA. z a MATERIAL I INTERNAL -GAUGE SLO i,-SIZE CE_ BEN,_, <br /> GRADE DIAMETER OR WALL IFANY. MENT TONITE R11 FILTFP, PACK <br /> .;:L.% to FL '(Inches) THICKNESS (1400) Ft. IQ Ft. <br /> Y. <br /> f <br /> ATTACHMENTS(�) CEATIFICATION STATEMENT <br /> the Undersigned,certify.that'this report it.:,complete and accurate to the best of my kn6wledge,and <br /> Geologic.Log <br /> Well <br /> Construction Diagram NAME 140 0-1-%lof— <br /> Geophyikal Log(s) <br /> Soll/Water Chemical Analyses <br /> C;TT--, STATE -rip <br /> o' <br /> Other_' <br /> ATTACH ADDITIONAL wFoRw non, IF IT Fxv;T.q. Sigrrad <br /> _j T � -ZI LICENSED WATER 1VELL CMTFACMR0XII SlkE, <br /> C-57 JCENSE*8N._ <br /> Dwil)m-kv.05-0.1 IF ADDITIONAL SPACE 13 NEEDED, USE NEXT CONSECUTIVELY.NUMBERED FORM <br /> ponjeUuaAlI!9:UJ0JJ C[ZCVOLGI.VI (1vqo)zq:0v L Z LZ-LO-60oz 0 io 0 L 915ed 4:)!8 of <br />