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'The free Adobe Reader may he used to view and complet. o m. However,software must be purchased to complete,sh d reuse a saved form. <br /> File Onl�inal with DWI State of California DWR Use Only—Do Not Fill In <br /> 'Page I-- of _ r Well Completion Report <br /> Refer to Instruction Pamphlet State Well Number/Site Number <br /> Owners Well Number - No. e0106898 I II NI I I I Iw <br /> Date Work Began 3 IB Date Work Ended Latitude Lon itude <br /> Local Permit Agency C0607- <br /> Permit Number Permit Date ZSh 0 APN/TRSIOther <br /> Geologic Lo Well Owner <br /> Orientation Vertical O Horizontal OAngle Specify Name Now FARMS .=n!c- <br /> Drilling Method Drilling Fluid <br /> Depth from Surface Description Mailing Address lbo <br /> Feet to Feet Describe material,grain size,color,etc Ci Slate L!!f—Zi 9 -L3 <br /> r Well Location <br /> t.r f Address l'e'iae <br /> ct.-1 G'ut 5� arty City __ 144 zry3g r—'i _ County �r�utfl <br /> Latitude N Longitude --W <br /> S �rrt �1fV r a(u �' Deo. Min. Sec. Deo. Min. Sec. <br /> r- Out Datum 151105 Decimal Lat.37.?92/j/ Decimal Longe <br /> APN Book Page Parcel <br /> 7J SSk to c Ina 5 t Township Range Section <br /> �f " L _Activi_ � � ty <br /> Sketch MUSS be drawn b hand alter form is p rimed. O New Well <br /> North O Modification/Repair <br /> O Deepen <br /> Y ' <br /> O Other <br /> 16a tarf�a.r� 2r4111r Destroy <br /> Gescdbe procedures and materials <br /> �/ under't3EOLOGiC LOG' <br /> Planned Uses <br /> k O Water Supply <br /> ©Domestic ❑Public <br /> ❑Irrigation ❑industrial <br /> O Cathodic Protection <br /> g - O Dewatering <br /> O Heat E xchan <br /> sa 9 O Injection <br /> P O Monitorin i <br /> O Remediation <br /> O Sparging <br /> South O Test Well <br /> _ lihmtraoe or describe distance of well from roach,bull&ngs,fences, O Vapor Extraction <br /> rivets,etc.and attache map,uee.ddhIonei paper Ifnea—my. O Other <br /> PI-1.be ecwrate etM co bte. <br /> Water Level and Yield of Completed Well, <br /> Depth to first water (Feet below surface) <br /> Depth to Static ■d <br /> Water Level, lv IA (Feet) Date Measured <br /> Total Depth of Boring `3 Feet Estimated Yield` <br /> (GPM) Test Type <br /> Total Depth of 6 I ted-►/Veli �2 �' Feet Test Length - (Hours) Total Drawdown """" (Feet) <br /> May not be representative of a well's long term yield. <br /> Casings Annular Material <br /> Depth from Borehole Wali Outside Screen Slot Size Depth from <br /> Surface Diameter Type Material Thickness Diameter Type if Any Surface Fill Description <br /> Feet to Feet Inches Inches Inches Inches Feet to Feet <br /> 0 3 1 < rl;rrorr tue G 3 <re•n C4 ke- t t,r <br /> I Sa o — c2rne:+fi <br /> 21 c (/C d a D.02 <br /> nen <br /> Attachments Certification Statement <br /> ❑Geologic Log 1,the undersigned,c rti that this report is complete and accurate to the best of my knowledge and belief <br /> 11 Well Construction Diagram Name wp <br /> Person,F3 or Carpo tion y� I / <br /> El Log(s) M6/ MSP r t/�.�r.'t ri Ioh�►�c.iU CA 9106 <br /> ❑Soil/Water Chemical Analyses dares city �— state zip <br /> ❑Other Signed_ 3 Ll Ii _a$332& <br /> Attach additional Information it It exists. C-57 Licensed Water Well Contractor Date Signed C-57 License Number <br /> DVJR 189 RFV 117(N1Fi rr enn,r�+�,.. ter•- ,�•err r c. , _ ,. .. ... --.. <br />