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ORLINAL STATE OF CALIFORMA F I <br /> File With DWR WELL COMPLETION REPORT 14159L ECPN� <br /> .t'age/Ol� e Refer to Inseruoeson Pampblet STATE WELL NO r8 ATION NO <br /> owner's 1Vell NO, "`t No. 471604 <br /> ry' ri }} <br /> Date Work Regan R , Ended �� .L U 4 La�E LONGrms£ <br /> Local Permit Agency All — Er vj <br /> Permit No. Perlaut Date <br /> GEOLOGIC LOC �` WELL OWIVBR <br /> ORIENTATION (✓) VERTICAL _HORIZONTAL ANGLH _(SPECIFY) Name` W '2�`laG t!i♦ a rya!T <br /> DEM TO FIRST WATER—M)RELOW SURFACE Mailing Address <br /> o rROM <br /> M Aett DESCRIPTION sQA&L V 1 ` ,� ` C <br /> Ft_10F t Dmalre mMnal,gram talar,GfG, ^ c CRY <br /> ti <br /> WELLrAOCATION STATE ZIP <br /> 1 t •,�- , ty� <br /> rCZ County <br /> Section!91 5 PIN, 9CIA1.1 f <br /> �d N �. Lsthgude NORTH <br /> _ � `•.', - a ;,~ , ` bEG Malt 8EC Longitude-OED-i hUN ' g��vvEST <br /> `, ;,•,` I,u /w f LOCATION SKETCH �TIVITY (4) <br /> NORTH NEW WE; <br /> 1 S ' � 5 �t�► S'� � IyoDIFreAT[ONrREPAIR <br /> Other(Upecitr) <br /> + l! ; .If �:r1 7 1 •s O j N _DESTROY faaamb. <br /> /(/ •s• t 5a `� 1PBrorda!Y?Fvan <br /> pGOals <br /> NED <br /> >ti rn )'t,ANlaoNm�n aE(S) <br /> WATER SUPPLY <br /> r • rJJ a ✓' Omeealta <br /> t iJr71 <br /> 1� ..� Ptmi1¢ <br /> VA All <br /> Ltdusidd <br /> TRST WELL" <br /> B�11 <br /> A6 A <br /> SOUTH —T1o0�PAOTEG <br /> i W lUawrate or Ducrt6e Dismace of well frarn Landm;;i OTNEA(SpecitR <br /> such at Roo& Ba1IJIr1�r Falrxa Riusrs,etm <br /> PLEASE RE ACCil1(,!!PE& CDMPLINC <br /> LE7B <br /> i i r M r !♦ IOiARNEftM 4dI'�� � i � FLUID <br /> , y <br /> t l r. WATER L&E & YIELD OF COMPLETED WELL <br /> DEPTH OFSTATIC / <br /> WATER LEVEL— t25 (Fla a DATE MEASURED <br /> ' ESTIMATEO YIELD'l _ captut) &TEST TYPE A44 <br /> TOTAL DEPTH OF BORING _.(Feet) TEST LEN(i71f�f� (Hr.) TOTAL DRAWDOWN_NA (Ft) <br /> TOTAL DEPTH OF COMPLErM WELL '(Feet) •,flay tent be reprnmtateve of a wdl)r Jo7wurm yield <br /> DEPTH BORE- CASING(S) ANNULAR MATERIAL <br /> FROM SURFACE HOLE TMM <br /> FROM SURFACE TYPE <br /> DIA MATERIALI INTERNAL GAUGE SLOT SIZE � BENORADE DIAMETER OR WALL IF ANY FILTER RACK <br /> Ft to Pt (tattles) THICKNESS pnehae! F( to FL iMBNT ONITE FILLAI (�} ( } (✓} (TYPElSIZq <br /> 1 <br /> W10- NS SA40 <br /> AA <br /> 2 CJ G A& Jt SeA o P.Afn <br /> ' 1 N <br /> ATTACHMENTS {✓} CERTIFICATION STATEMENT <br /> G04W69 c Lag I,the undersigned aed f lhat this report is complete and accurst to the b at at my knowledge and belief <br /> ff t <br /> Well Coastructlon Dittaram NAME ti ♦ LN C �JIA�� <br /> Log(s) <br /> (PE fl OR TMR) (TYPEDOR MATED) WOF <br /> �.-- Gooptryah7at } �1 <br /> — SoYlWaterCharTWaslAestysss �` CkAn FL. <br /> Cost STATE <br /> 3(godATTACH AJWWmAL AVF0AIU47RIF IT EMTS W / b <br /> T NSE NUMBER <br /> DWRlea REV T-W IF ADDITIONAL SPACE IS NErz6m. US v <br /> JEXT CONSECUT4LY NUMBERED FORM /77 <br />