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1 <br /> ORIGINAL STATE OI• CALIFORNIA D.3%n Af_ go a r L r <br /> Etre with DWWELL CQII�PLET4N REPORT r �� J <br /> Palp£ _MW <br /> � / Refer to 1werectton Pamphllat STA WELL 0JS A No <br /> Owner's Well No !IYMO 4 G QQ_ ❑ ❑ <br /> Date Work Regan ,E �er e° YI�A+►Ifit/L LATITUDE LONanUnE <br /> LOcal Permit Agency • i ' Z <br /> Permit Na. PermiL Date APN1IVAt=KR <br /> GEOLOGIC LOG WEL� WNER �----- <br /> ORtFHTATidN (✓) vflgrrOAL —NOgIZONTaL. —ANGLE ,..,.,,_{SPECIFY) Nan1e <br /> DEPTH Ft1tlAt DEPTH TO FIRST WATER (FL)BELOW SURFACE Ning Ad BSS • . Z015 <br /> auTaP,rt DESCRIPTION " ` l <br /> Ft to Ft cube maeerml f$e cola.VA ` TY � LL•7,O ATTIO N aTa7f: ZIP <br /> Ica ark wel _wth:� Ad4ress ft <br /> t <br /> �1 er . �lr , <br /> ' lrnunt)/ <br /> ti <br /> llPN Bonk -Pag�Parcel <br /> Towr4up Ravage Section <br /> -- <br /> _ Longitude 1_ 1 YVEST <br /> r .Latitude D a in SEC ND Dec Aar+ sEs <br /> r rc, Ai- <br /> velrti - ' LOCAIION SICRTCH ACTIVITY 1✓) <br /> NORTH NEW WELL <br /> , t <br /> ` � .y� AlooiFlceTlonm>:YPaEp <br /> t ' • • �` 'TS/ —Deepon <br /> ' L •'i i —ether tsplrpfy) <br /> L � ti <br /> iTf'STnOY lttaec,+e+ <br /> ' ' Procedur+sondMourl+la <br /> 03dar GEOLO=Lna J <br /> �- PLANNED USES) <br /> , �rlowrormae <br /> t <br /> WATER suPPLY <br /> 1 I <br /> .^ Plleac <br /> �. Irdonl,on <br /> i <br /> Induatrrel <br /> t , <br /> �,. 'TEST WELL' <br /> 1 , <br /> 1 <br /> SOUTH T ouHOD'c PROTE[a <br /> ilhfafrare or D twrftie DfalanC4 of 1Ndl jrorn Landm nT. �OTHER(Spoerty) <br /> P&W19 8B A['�lCUAIn tl7E G COMPLETE <br /> 1 i <br /> METHOD 1Te FLUID <br /> t t <br /> WATER LEVEL & YIELD OF COMPLETED WELL <br /> 1 1 DEPTH OF STATIC <br /> WATER LEVEL (Ft.) $ DATE MEASURED <br /> e t <br /> ESTIMATED YIELD' (QFM) &TEST TYPE <br /> TOTAL DEPTII OF BORING (Feet) TEST LENGTH-Oft) TOTAL DRAWDOWN (FI) <br /> TOTAL DEPTH OF COMPLF T'ED WELL (Feat) •May rwt be reprwetuattr,e o/a well3r long tmn yield <br /> DEPTH CASING(5) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE SORE' TYPE ✓ FROM SURFACE <br /> I DIA.E � MATr;RIAL! �RNAL GAUGE SLOT SIZE �SEN� SPEGRADE DIAMETER OR WALL IF ANY IIIL! FILTER PACK <br /> Ft to FL (inches) THFCIWESS Uedtea) Ft to Ft ✓) (TYFf:/SIZE) <br /> t � <br /> + 1 <br /> 1 , <br /> t , <br /> 1 , <br /> ATTACHMENTS (4) CEIITIFICATION STATEMENT <br /> _ Goompra Lop L,the uederalgriled,p�cortttiiiffythat this report 1a complete and accurate to the beat at my knowledge and belief <br /> Well conafridood Diagram NAME� l <br /> {•{ ,UA Ca t IITIDLIj?"Ela p <br /> ._.._ 3oUHWater chemical Atialynas 1 <br /> a <br /> CITY STATE ZIP <br /> Other - /�fa{/; <br /> ATTACH Art n0jyAL INFORMATM IF Jr Eaf7STS. S1900. +fj <br /> INDIt'ZE REPRES JAIE SIC[{ED C47 t9EM NUMBER <br /> DWRISSSFY 7.9D IF ADLgTIONAL SPACE IS NEEDED, L1SE N E_MT1VELy N11M13r=R>D FOJIM <br /> l <br />