Laserfiche WebLink
ORIGINAL STATL O1 C,1111'1I DWR USE ONLY — DO NOT FILL IN <br /> File with DWR WELL COMPLETION REPORT I i I I <br />' STATE WELL NOISTATIDN NO Pageof ! <br /> Rfa <br /> cr to lustrrr(txnr Pampld(t ElO.incr s Nell No r� No 811083 <br /> D ItL AN oIk BeL,an S Ended ��IZ9 19 t LATITUDE LONGITUDE <br /> Loc it PL I n}tt -1,etic� l` CO$rl M N1 P H S <br /> F11.1)n <br /> /'� ^ AR`1lTR]GTti ER <br /> 1 L, ill, \t) Sl.1_t ZZ !PPLrmlt D Rte L <br /> GEOLOGIC LOG I11 ELL 01l`Ex <br /> ORIENTATION VERTICAJL� —HORIZONTAL —ANGLE _(SPECIFY) \ame " Q f So It o Q Ih.DRILLINGr <br />' METHOD `• A F FLUID NO __ \Iultrit� aclLlt[�S Zf W� <br /> DEPTH FROM C,, K tV�/I, 1 C 9 5 Z b <br /> SURFACE DESCxIPTIo\ �tC <br /> P Io FI <br /> DI s(rih( mutt)i(d ,rrttn stz( color (1! CITY STATE ZIP <br />' 11 VL III V;o\ r <br /> ldtltuti, <br /> T- <br /> tgetliI logCtt\ ca C <br /> collet\ - ry h o a Lt (k- <br /> -V\ Bout. Z3 S 11wi1 .7 _PtrccI y <br />' To%\llship Rtil-_Ti. SLctton <br /> EST NORTH Lcln(�It11Clc L , W <br /> Latthrdc� - <br /> DEG MIN SEC DEG MIN SEC <br /> LOCI TIO\ SKETCII 1ICTIN tTl (:) - <br />' NORTH -4 NEW WELL <br /> ( MODIFICATIONIREPAIR <br /> Deepen <br /> — Other(Specify) <br /> DESTROY <br /> I Q Q till,N escnoa <br /> Procedures aCnd Malenal5 <br /> t 1 Under GEOLOGIC LOG <br /> Sly-}-e- P j R YL PLANNED USES (Z�.) <br />' I I WATER SUPPLY <br /> Domestic Public <br /> t ( Irrigation Industrial <br /> ( i w ¢ MONITORING <br /> w <br />' I , TEST WELL <br /> r I CATHODIC PROTECTION <br /> HEAT EXCHANGE <br /> I <br /> DIRECT PUSH <br /> INJECTION t ' INJECTION <br /> I VAPOR EXTRACTION <br /> SPARGING <br /> 1 I SOUTH REMEDIATION <br /> fllintutte<,r DLSLrrbL Distrincu of 11 ELI(pint Roads Boudoirs <br /> t , Fences Ricers etc and attach a lila LTC additronel k1�(IPLr rf OTHER)SPECIFY) <br /> necesaanj PLEASE HE ACCURATE '&COIfPLE9-E <br /> ` RATER LENEL11 RR& ]IELD OF COMPLETED WELL <br /> i DEPTH TO FIRST WATER (Ft} BELOW SURFACE <br /> DEPTH OF STATIC fa <br /> yh� <br /> t � WATER LEVELL-(Ft(&DATE MEASURED �' <br /> II <br /> ESTIMATED YIELD {GPM} & TEST TYPE P t % P <br /> TOTAL DEPTH OF BORI\C {Feet) TEST LENGTH 10-11-1; (Hrs) TOTAL DRAWDOWN 2 (FI) <br /> 1 TOTAL DEPTH OF COMPLETED A1ELL (Feet) *May not be iepiesentarize of a zelli tont;-terwu yield <br /> CkSI\G (S) DEPTH ANNLLIR MATERIAL <br /> DEPTH BORE FROM SURFACE TYPE <br />' FROM SURFACE HOLE TYPE(_) <br /> DIA Y z d MATERIAL/ INTERNAL GAUGE SLOT SIZE CE BEN <br /> i,sl <br /> DIAMETER OR WALL IF ANY MENT TONITE FILL FILTER PACK <br /> Ft to Ft <br /> (inches) a s or; GRADE Fi to Ft ITYPElSiZE) <br /> m v c�� � [Inches} THICKNESS (inches) ,r ,! <br /> a 75 -L sZk 0 — Kr <br /> z0 11 z o. 0 10Soh <br /> I <br /> I <br /> 1 <br /> i <br /> i <br /> �\TTACHNIENTS CERTIFICkT10N STATEMENT <br /> I the undersigned Certify that this report is complete and accurate to the best of my knowledge and belief <br /> Geologic Log ;l <br /> Well Construction Diagram NAME v + W Dt-MNg , h G <br /> IPERSON FIRM OR CORPORATION} (TYPED OR PRINTED) <br /> Geophysical Log(s) R p 151 R ev \r l,5 t� CA <br /> 91+51 LLC1 <br /> Soll/Waler Chemical Analyses a0 ZIP <br /> Other S i te t �R k- ADDRESS CITY STATE S <br /> ATTAGN ADplT10NAL 1NFORMATlON 1F 17 E)[lSTS Signed ` / /17 <br /> -+'10 <br /> �0 O <br /> WE DRILLER/Ago REPRESENTATIVE DAT SIG D ^^ C 51 LICENSE NUMBER <br />' D\\n ttti RIF% 11(r IF ADDITIONAL SPACE IS NEEDED USE NEXT CONSECUTIVELY NUMBERED FORM <br />