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O1IADRUPLICATE
<br /> � STATE OF CALIFORNIA DWR USE ONLY — DO NOT FILL IN
<br /> For,Local Requirements Ea,, WELL COMPLETION REPORT
<br /> • Page Of I Refer to Instruction Pamphlet STATE WELL NO./STATION NO.
<br /> Owner's Well No. 11 " 1'C 2 3 1992 Na' 413 l 9 8 1:1 El
<br /> Work Began 3 t ��xj 1 IJ L R' �'L. LATITUDE LONGITUDE
<br /> #;..' fit r-4EA
<br /> Local Permit Agency C-44firbis I
<br /> Permit No. ' ;.'., . , .. Permit bate I L 2 APN/TRS/OTHEg
<br /> GEOLOGIC LOG WELL OWNER pp
<br /> ORIENTATION (�) _`VERTICAL _HORIZONTAL _ANGLE _(SPECIFY) Name �; `= - r' la N '�N Ei:R I N l.i .
<br /> DEPTH FROM DEPTH TO FIRST WATER (Ft.) BELOW SURFACE Mailing Address #`` `fit NELz!`- N ;`)VE ,. STIE 1,
<br /> SURFACE DESCRIPTION .y .i'�`.�-�,01!t`1.'r .`,: {➢.1kx;11)
<br /> F. to Ft. Describe material,grain size,color,etc. CITY STATE ZIP
<br /> WELL LOCATION
<br /> Address 'Ft!`i`f is vis V I ! F.1-ANE ARNSTRUTO
<br /> JAA.: Cit
<br /> Ii ih i '1 Ir Y WH I TF. y
<br /> CountycTAY
<br /> i APN Book Page Parcel
<br /> ANU M1..1LTIti a£.;IOR or
<br /> Township Range Section
<br /> Latitude r NORTH Longitude I I WEST
<br /> .) � DEG. MIN. SEC. DEG. MIN. SEC.
<br /> " .3 A " LOCATION SKETCH ✓
<br /> 'IK .`�'"',} -i..., ACTIVITY (—)
<br /> I 5t III •)1,+J„ I: r t NORTH _'NEW WELL
<br /> r' r ,;.•i i; ( B ;: ,j. r IAY
<br /> MODIFICATION/REPAIR
<br /> - ..i']: � .,ii •,`y _Deepen
<br /> '( , Other(Specify)
<br /> Ir
<br /> t t e A 14 V ;} t
<br /> _.
<br /> i u €. , yl f F'1'• _DESTROY(Describe
<br /> {_ a Procedures and Material.
<br /> I i .. 1 ,( -5 (, ylr,.' Under"GEOLOGIC LOG")
<br /> CO ( PLANNED USE(S)
<br /> SHALE LU U)
<br /> i: n 3 w MONITORING
<br /> .r'te's' ASF,'• ;�Fitd 1.)SS,�,
<br /> ( 'i? ,I W - x L'+ } 'ri ,eJ 1 i .....+,..•M•'+ _ WATER SUPPLY
<br /> (.: 3,. %'JAY �,., �.' ` F _ . ..... _ Domestic
<br /> +` �.. Lat1'
<br /> (rIJ it ; Public:
<br /> } , a% .'.." ^"". _••—.....1. Irrigation
<br /> , 1bt,139 CLAY
<br /> Industrial
<br /> "TEST WELL"
<br /> CATHODIC PROTEC-
<br /> SOUTH TION
<br /> Illustrate or Describe Distance of Well from Landmarks — OTHER(Specify)
<br /> such as Roads,Buildings,Fences,Rivers,etc.
<br /> PLEASE BE ACCURATE & COMPLETE.
<br /> DRILLING
<br /> METHOD FLUID
<br /> WATER LEVEL & YIELD OF COMPLETED WELL
<br /> DEPTH OF STATIC . % ,� Ir
<br /> WATER LEVEL (Ft.) & DATE MEASURED
<br /> ESTIMATED YIELD' (GPM) & TEST TYPE
<br /> TOTAL DEPTH OF BORING (Feet) TEST LENGTH (Hrs.) TOTAL DRAWDOWN (Ft.)
<br /> TOTAL DEPTH OF COMPLETED WELL (Feet) *May not be representative of a well's long-term yield.
<br /> CASING(S) ANNULAR MATERIAL
<br /> DEPTH
<br /> BORE- DEPTH
<br /> FROM SURFACE HOLE TYPE( FROM SURFACE TYPE
<br /> INTERNAL GAUGE SLOT SIZE
<br /> DIA. r z c = MATERIAL/ DIAMETER OR WALL IF ANY CE- BEN- FILTER PACK
<br /> (Inches) z GRADE MENT TONITE FILL
<br /> Ft. to Ft. m N _ (Inches) THICKNESS (Inches) Ft. to Ft. (✓ ) (✓ ) (✓ ) (TYPE/SIZE)
<br /> i
<br /> i
<br /> r
<br /> ATTACHMENTS CERTIFICATION STATEMENT
<br /> — Geologic Log I,the undersigned,certify that this report is complete and accurate to the best of my knowledge and belief.
<br /> _ Well Construction Diagram NAME
<br /> (PERSON, FIRM, OR CORPORATION) (TYPED OR PRINTED)
<br /> Geophysical Log(s)
<br /> 181.9 L,O',f 1MR 1 L-:7 E f(:.,)A i:) , F€T'M 8I1R%.3
<br /> Soil/Water Chemical Analyses
<br /> ADDRESS ,..� %�` CITY STATE ZIP
<br /> Other
<br /> d ,..�",- ..�-.f_,:• � ��,',sr.•+..... � ' .., � ''.,.
<br /> ATTACH ADDITIONAL INFORMATION. IF IT EXISTS. Signed
<br /> DRILLER AUTHORIZED REPRESENTATIVE DATE SIGNED C-57 LICENSE NUMBER'
<br /> DWR 188 REV.7-90 IF ADDITIONAL SPACE IS NEEDED, USE NEXT CONSECUTIVELY NUMBERED FORM
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