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ORIGINAL STATE OF CALIFORNIA ONLY — I IN <br /> File with DWR WELL COMPLETION REPORT <br /> rug,AL of—,3-- Refer to Instnection Pamphlet STATE WELL NO!STATION NO <br /> Owner's Well No, �'� Ca'a� a- Na• `e03452 Y IF, ❑ ❑ <br /> Date Work Began aQ05 , Ended f LATITUDE LONGITUDE <br /> Local Permit Agency ,n : C r t C I� � <br /> � ,nvt a <br /> Permit No APN/TASIOTHER <br /> Permit Date_ !O _ � <br /> / GEOLOGIC LOG WELL OWNER <br /> ORIENTATION (4) v IERTICAL _NORIZONTAL —ANGLE _(SPECIFY) Name CC� <br /> DRILLING <br /> DEPTH FA OM METHOD FLUID M g Address 1PrJ4 <br /> SURFACE DESCRIPTION <br /> Ft to FL Describe inatertal grain size, color, etc CITY STATE ZIP�� <br /> p p WE acATro <br /> t , G <br /> Address a� <br /> City��� c , - — — <br /> County_ ► <br /> 7 <br /> ... %-0 — <br /> r7 APN Book Page Par',] O� <br /> xa v 5 <br /> Township Range Section NP <br /> Latitude DEG. MIN SECORTH Longitude/Tz`r-/I DEG M�e �IN SEC <br /> LOCATION SKETCH ACTIVITY (�c) <br /> NORTH <br /> ..._ NEW WELL <br /> I e <br /> MODIFICATION/REPAIR <br /> Deepen <br /> Pau DESTROY(Describe <br /> t I <br /> Procedures and Mateatarfals <br /> Under GEOLOGIC LOG <br /> I PLANNED USES (4) <br /> I t WATER SUPPLY <br /> , Domestic Public <br /> ,._ tenpstion Inlowlal <br /> ' ! MONITORING <br /> t I <br /> TEST WELL <br /> ' CATHODIC PROTECTION..— <br /> I HEAT EXCHANGE <br /> I DIRECT PUSH_— <br /> I e INJECTION <br /> VAPOR EXTRACTION_ <br /> 1 <br /> SPARGING <br /> I I SOUTH REMEDIATION <br /> I111utade or Dewrihe Dlziauce rtf Wril f(rteul Rfevds Bufkllll<,(.r <br /> I I Fences Rivera ett mid attndl a urrtpp Usr ndditlg }�r.,1 OTHER(SPECIFY)— <br /> nresamnJ PLEASE BE ACCURATE b COMPLETE" <br /> I <br /> I I <br /> WATER LEVEL & YIELD OF COMPLETED WELL <br /> DEPTH TO FIRST WATER (FL)BELOW SURFACE <br /> DEPTH OF STATIC <br /> WATER LEVEL (Ft)d DATE MEASURED <br /> e <br /> ESTIMATED YIELD (GPM)A TEST TYPE <br /> TOTAL DEPTH OF BORING rFeet) TEST LENGTH (Hm)TOTAL DRAWDOWN__(FI) <br /> TOTAL DEPTH OF COMPLETED WELL (Feet) *May notben uentatweJr.zve!!'f!on -term ylctd <br /> DEPTHCASING (Sy <br /> BORE- DEPTH ANNULAR MATERIAL <br /> FROM SURFACE HOLE TYPE(;) FROM SURFACE TYPE <br /> DIA MATERIAL! INTERNAL GAUGE SLOT SIZE CE BEN <br /> F7 to Ft (inch-) GRADE DIAMETER OR WALL IF ANY MEM TONITE FILL FILTER PACK <br /> (Incas) THICKNESS (Inch") FL to FIL (�) {�) (�) UYPFJSIZE) <br /> t <br /> 1 <br /> I 1 <br /> I I <br /> I I <br /> I ATTACHMENTS (4) CERTIFICATION STATEMENT <br /> Geologic Lop 1,the undersigned,certify that this report Is complete and'accurate to the best of <br /> my knowledge and belief <br /> We11 Constrictionta <br /> D(aprit NAME R� (� oa, /vim <br /> GoophyslCel Log(s) IPERSON.FCu,6—lz <br /> R CORPORATION) (TYPE�DD OR Pltlmm) <br /> v �oR/water Chm alysee 55'0 fes.E) k �7 d S'r� 5�� ! <br /> ,]L Other f ADDRESS \ CITY STATE ZIP <br /> ATTACH ADDITIONAL INFIAMAIK7 1F lT EXISTS Sg-' 4-qL'kr. ?�a <br /> WE <br /> IE C 57 LICENSE NNGER <br /> uWR faits Atv 1I Ir IF ADDITIONAL SPACE IS NEEDED USE NEXT CONSECUTIVELY NUMBERED FORM <br />