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L ,00 1G DIAL STATE OF CALIFORNIA - ,rDWR USE ONLY — DO NOT FILL iN 71 Fill wit1h DWR [ LL COMPLETLON.°REPORT.Page—_1___of I Refer to Inst'r-uction Palinphlet STATE WELL NO.ISTATION NO Owner's Well No. yy _ No. 0948167 T 1 1.. 1. Q , Ended 11 1 -0LATITUDE LONGITUDE L Date 11 ork Bega�� I Local Permit Agency SAM T dQ CO �N 'C Q\ iY - Q D n APtJITRSIOTREA Permit No. S # Permit.Date V GEOLOGIC LOG ( `.+' �y (� *'_WELL OWNER 'y N ORIENTATION (�') �'VERTICAL �._HORIZONTAL —ANGLE _(SPECIFY) Nal77e `ry "� r�� C��y��A�VJ� �" r DRILLING 3j /� r �Z. FrlSA-6 T$ ANENV L METHOD N$ •�Vy�R " FLUID N 0 N E - �maAiiTg A�re'.SS, r : _ DEPTH PROM DESCRIPTION A S SURFACE Ft. to Fi, DC•SCY7lJC 77t¢t2rtCl1, �Pr(liR .Size, Color 2tG CITV.ti'b �� y'1 � %F 1 STATE ZIP LIONTSVE `L L ION Ac�tlress `vd� I1 6outity APN Book IV� Page_._NA—ParcelNA WELL WAS ''.Q-� q `i''' ; TowiT5liT1�, Range Section 0 V L R RRA L L11 N G,144�,, E N.T `` LotI I N Long w r!' DEG- MIN. SEC. OEG. MIN- SEC, L4 • L NN t `�S �' G (W��"�i►N` �y' LOCATION SKETCH ACTIVITY (�I r I C S.*. i 1 LeU'4 vcV A:4V V'.: �Z _ NORTH i �+ n'�/� �y �j n ` fl t.' NEW WELL. —4 Nit yX414"" j'.�`li.l'-.It 1�:.. �ui, H 0 L 4.V-'1'V,��Rr':! � MODIFICATIONfREPAIR I I M i J Q+T,.A_5 Deepen Other(Specify) L , ..r 1,r ``T k V h r I ' F'T13:0-kA N ALL yy C L` DESTROY(DeScriUe Procedures and Materials 'AS4.t kr MA1,19,.'AIS W L A L 5 L C SLTE PLA ht Once,"G@OLOGlC LG') 'IBE M 0 V4` A V LA Rr USES (�) ";.—VEAL _.,R, L UK W .t T A G N U WATER SUPPLY 4 iL L -0 LV, , 1 t Il — _ — Domestic _____ Public BORE- r Irrigation — Indusia I HOLt WA HUED W 11 €A (� l . ..i'J Id MONITORING I I 0 V .YS.1 N f 1J` TEST WELL I I IBEMIE PIPE. CATHODIC PROTECTION HEAT EXCHANGE _ DIRECT PUSH `VRGE WAS R WOREQ BY t� k �1 �] J� INJECTfON it I ^�i'7r� p1 N y 1 K/, L S CAV I's - VAPOR EXTRACTION l 1 rl rC ft .�' A N D TT-T c H- SPAflGING I I 1 N THE 'l WITH SOUTH REMEDIAThCN • l Illustrate or Describe Distance of Well from Roads,Buildings. I I CID _� n -.S Q Fences.Riters,etc.find attach a rnap USC additionuI ppaler f OTHER(SPECIFY) necessanj.PLEASE BE ACCURATE&COMPLETE. WATER LEVEL & YIELD OF COMPLETED WELL l I DEPTH 70 FIRST WATER 913 (Fl.) BELOW SURFACE DEPTH OF STATIC WATER LEVEL. /� (Fl,)&DATE MEASURED 1111 los I I ESTIMATED YfELD�1'A NA (GPM) & TEST TYP,E1� TOTAL DEPTH OF BORING \ (Feet) I TEST LENGTH + (Hrs.) TOTAL DRAWDOWNf_!_i',] (Ft.) TOTAL DEPTH OF COMPLETED WELL, r2 Q {Feet) *May riot he repre e'nfative of a well's long-term yield. DEPTH _ CASING (S) DEPTH ANNULAR MATERIAL FROM SURFACE BORE HOLE TYPE O FROM SURFACE TYPE DEA. x w o MATERIAL 1 INTERNAL GAUGE SLOT SIZE - - CE- BEN- (IncheO Z ¢ w a GRADE DIAMETER OR WALL IF ANY MENT�TONITE FILL FILTER PACK Ft. to FL Ft. to Ft, TYPEISIZ£ //�� coo u (Inches) -- 7HfGKN£SS (inches) ( ) 20 19 P V C 25G 14 40 0 . 010 0 ✓ #3 SAND I 4 ATTACHMENTS (.!L) CERTIFICATION STATEMENT / I, the undersigned, certify that this report is complete and accurate to the best-of my knowledge and belief. Geologic Log h _ Well Construction Diagram NAM£ `r?u S E 4' R A M KG V O K A L t W U L b A N D o M N T _ (PERSON, FIRM,OR CORPORATION) ORPORATION) -(TYPED TYPED OR PRINTED) Geophysical Log(s) SoillWaterChemical Anaiyses 46 MERCHANDISE WM A_M O n S p RI N VJ CA 95619 Other Sa icLAN _ ADDRESS CITY r STATE Q 2ZIP p ATTACH ADDITIONAL INFORMATION, IF IT EXISTS. Signed i 4 2 7 9 6 1.5 J r C-57 LICE ED WATER WELL GON RACTOR DATE SIGNED G-Sl LICENSE NUMBER .DWR 188 REV. 05-03 IF ADDITIONAL SPACE IS NEEDED, USE NEXT CONSECUTWELY NUMBERED FORM .._, OSP. a3 78636