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r 'ORIGilQiAL SCAI'E Or CALIFORNIA "f� r0rILL 11 <br /> RIG with DWR WELL COMPLETION REPORT <br /> Page p 7? Refer to Inriructrra"Pamphlet { SIA {L1 MVMA=N NO <br /> OWFICeF Well No . Ixw � • 471603 <br /> Q <br /> � u• <br /> Date Work Began �/� -1� , Ended LATITWE r LamorruOE <br /> Local Permit Agency n+rb m ' <br /> Permit Na .01 Pernut Date _ <br /> CEOLOCIC LOG - t WELL OW14ER � <br /> ORIENTATION (jt'_) VERTICAL _HORIZONTAL _ANGLE _(ePSCIFY) Haran•+ •'3 V� t A 7_.1` <br /> DEPTH PROM DEPTH TO FISSC WATER Mt MOW SUNFAM Malltng~Addru E�"r 5y- T� <br /> sM"WACE ,, DESCRIPTION �`t`, }'`• `a <br /> Ft to Ft A-crib- ><aterur4pnpS lr Cdor de ,N', L' curt WELL LOCATION STATE ZIP <br /> C—LAAr <br /> 43f I County <br /> leo a^ ,4 PN Book Paged Parcel <br /> + <br /> low Range Range _Section <br /> r 3 �•` Lltfttudc NowTlf Longitude i_._ W+sr <br /> DEM <br /> LOCAT �� <br /> ION SKETCH A�TIVITY (Z.) <br /> ' NORTH NEW Wv.L <br /> % , trIOQIFICATIONlREPA1R <br /> 1 f. r r f \ .�Da <br /> i4Z. i �, It l C.3 c "',8 . V4 ^' -almrs5pacllyl <br /> r 'r,e rjtr <br /> �DESTROYmeaarthe <br /> 5 ti Pmaudaras endAfeled. <br /> tMder Q1GLOGICL4W 7 <br /> e, .r F%eidt PLAN ED USE(S) <br /> MaNtr`0RWU <br /> r <br /> 15.5 <br /> r <br /> a <br /> n rn� WATER SUPPLY <br /> r !� S 'r' s �A\ ' i�i err+ S � J <br /> Damaehc <br /> i I <br /> ' IMpelTon <br /> . Zb L <br /> 1 e r r <br /> eA. k4usulel <br /> Z kry <br /> *wxr WELL, <br /> J�i/Z t au CATHODIC PROTEC <br /> ' r J oRa al SOUTH TION <br /> Ilhuardte or Describe Distance of Weft from Landmarb ........OTHER(SpeuUyl <br /> r r such at heads Burldrigs,Fencer,Rfnen,etc <br /> PLEASE BE ACCURATE!r COMPLEPL+ <br /> /1 <br /> M o 10d1Iu(;' .Ty 11SA <br /> r FLUID <br /> t mo. WATER LE EL do YIELD OF COMPLETED WELL <br /> DEPTH of STATIC <br /> WATER LEVE , 13•3f (Ft.) & DATE MEASURED � <br /> ESTIMATED YIELf,D'�AJ� (OPM) S TEST TYPE-V� <br /> TOTAL DEPTH OF 13ORM 2e i (Feet) TEST LENGTH +A(Hrs)TOTAL DRAWDOWN AM (FL) <br /> TOTAL DEPTH OF COMPLETED WELL(Feet) •May rant he reprmewanve of a+weUl-Amg-arm yield <br /> DEPTH CASING{S} DEPTH ANNULAR MATERIAL <br /> }TOLE RYV <br /> FROM SURFACE TYPE <br /> FROM SURFACE <br /> DML MATERIAL/ RUIETEINIERNAR WALUGE 8IF SIZE CMENE13ENCho* GRADE DIAIAETER HI WAIL (F ANY FILTER PACK <br /> Ft to Ft (Ineheal THICKNESS gnchao Ft to Ft (4) T(4) FILL (TYPE/GFZE) <br /> G <br /> Slkli O �-- <br /> S <br /> I(::)- 1.sr e- di`$ 4.0 f *11-ILIA <br /> `�f.artr� <br /> r ' <br /> r <br /> r , <br /> r , <br /> ATTACHMENTS (r) CERTIFICATION STATEMENT <br /> I,the uoderecgaed,certify, hat this rep fa complete a id acc rete to the best of my knowledge and ballet. <br /> • <br /> Well Canstruollan Inmram AfAME b.Vlv o <br /> OR EQ Ea Olt FJ}) <br /> — Geophlralosl!dp(s) , 9 Ys'2_0 <br /> — SaillWeterChamlaalAnaEyses <br /> ff— -ld <br /> CITY STATE ZIP <br /> .._. Other <br /> ATTACH ADDITIONAL INFORMATM AF IT EMTSI ^ <br /> Will ORttLM VAiMEMEL— <br /> E SIGNED Cbl UtEtM M SERWER <br /> DWRISSBEV 7-e0 IF ADDITIONAL SPACE IS NEEDED, US EXT CONSEC ELY NUMBERED FORAM <br /> > F 72- <br />