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"The free nal with <br /> Reader may be usedto view and comp� is form. However;software must be purchased to complete,File Original with OWR _ p A and reuse a:saved-form. <br /> State of California <br /> Page 17 of 17 Well COmpletlon Report DUse 00WIFE in <br /> Owner's Well Number OUY-10 Rets"to Instruction Pampiliet <br /> Date Work Began t}5114t2012 No;e0152711 �-- State Vt�u NumtrerlS�e Numtser <br /> Date Work Ended 5t16 t .. _L_ l�,t N W <br /> Local Permit Agency: t1Loatiuin Co tasty f=� ironr»ent^t� tt D� ..�'—. latitude tors nude <br /> Permit LVA �-�- -- ; <br /> Permit Date 51811.2 ltiPtSUTRs/tither . <br /> C,eolo is Log <br /> Orientation OVertical DAngle Specify 0Horizontal .. Well fawner � <br /> Drilling Method Hollow Stem Au er Name TOSte i=nr mS <br /> Drilling Fluid Bentonite mud <br /> [)Feet front Feet Cs t}escripttt n � Mailing,Address 24811 Taste Road <br /> Feet to Feet Des<xitie rrtatetiai rain size;calor,etc C t Trae <br /> 16 Q ©verdriti removi all weft materials. State-CA r 9937- 7 <br /> Well Location <br /> [AddressrtyCountyititude 1 M longitude : t <br /> Dan Min: sec <br /> Dlour Decimal Lat. Derr. Min <br /> A:}N�Book Decimal Erring <br /> 8 Page 61J9 Parcel 25 <br />` Ti wnshi Ran a Sec don <br /> Location Sketch <br /> iSketch must brt tlravm b hand atter far i is rrtgd: <br /> MOM 0 New Well <br /> Q ModificationtRepair <br /> 0 Deepen <br /> 0 Other—___, <br /> (E)Destroy �`" <br /> Ossa it*Weediaea mtd nota <br /> Und.ME <br /> t.0G: <br /> Planned Uses <br /> l l[r t Q Water supply <br /> ❑Domestic 0 Public <br /> : Otrrigation Qandustrial <br /> 0 Cathodic Protection, <br /> 0 Dewatering <br /> Q Heat Exchange <br /> 0 Injection <br /> 0 Monitoring <br /> 0 Remediation <br /> 0 Sparging <br /> South �&Test Well <br /> Irlusa'rte 4r tleadribe tfistaricu 41 we#1 rt4m roads.kuildifti"foram `"' <br /> . Vapor Extraction <br /> _ raven tic,end attach a map.Use edditiunai pnpei:ifnecessary� © Qttler:{,tZQrt�: <br /> Man t.mcwate and 4arrt tete... <br /> a;ler Level and Yield of Com feted if ~i <br /> Death to first water ' {Feet be#ow.surface}. <br /> De„tth to Static <br /> Weer Level (Feet) Date Measured <br /> Total Depth Of Baring >6 Feet Estimated Yield« <br /> (GPM) Test Type <br /> 'total Depth of Completed Well 16 Feet Test Length (hours)Total Drawdown <br /> {Feet) <br /> mir not be re reseritative of a well's lon term el <br /> d. <br /> Casin s AttnularMaterial <br /> Depth from t3ortahole Wall Outside Scresrn Slot Size Depth from <br /> Surra ttiet> ir TYPO Material Thickness Diameter T tr <br /> Feet to Feet lndtes Inches inches if Any Surface Fill Dendptlon <br /> inches Feet to Feet <br /> r <br /> .. ;, .Attafahnten#s � Gertlftcaton Statement <br /> ©Geologic Log I the.undersigned,certify aha#this re:aort fs complete and accurate to the best of my knowledge and belief <br /> Ca Well Construction Diagram NaiYte._All Well Abandonment <br /> ❑Geophysical Logs) r r Person.Fm,orGnrpnration <br /> , l € :3 attV Drive Suite A S crafne <br /> ❑SoiitWater Chemical Analyses �—�---^---�-- .._. $. <br /> Addre _---� -�A _ <br /> Cl Other Site Mao Signed -°�”� �. ,,:��== "ac--' 'ir state <br /> :" '�.. -�Y— 5/29/2412, 848359 <br /> Attach ad alienor iMamretion ititexists...... .' . . s" ltrsnseG Water Wel Uat <br /> on ;tar <br /> DWR yea REV,ynoos date Signed <br /> C-57 License NumberIF ADDITiQNAt:$PACE IS NEEDED USE NE7C CONSECUTIVELY NUMSE'RED FORM <br /> i <br />