Laserfiche WebLink
ORIGINAL STATE OF CALIFORNIA 12WEI USg ONLY — QO NOT EILL IN <br /> File with DWR WELL COMPLETION REPORT <br /> Page_-L of 3 Refer to Instn+etlan Pamphlet STATE WELL NOISTATION NO <br /> Owne:'s We-~~ VE15— a �lo�c a, No I F <br /> 11 No eOM23k, <br /> w� �'t <br /> to Work Began ,k O'I , Ended�I30l�i1e_S a LATITUDE LONGITUDE <br /> Focal Pen-nit Agency n ti t <br /> Permit No CO APNITRS/OTHER <br /> GEOLOGIC LOC WELL OWNXA <br /> ORIENTATION (�) _NZM1 LILL —HORIZONTAL —ANGLE <br /> DRILLING _(SPECIFY) Name Nae <br /> DEPTH FROM METHOD FLUIDihng Address % S <br /> SURFACE DESCRIPTION -7y'5-1 O <br /> FL to FI Describe material grain size, color, etc CITY Q STATE ZIP <br /> © , 0 DO LL LOCARIN <br /> + t t 5 yl` Address .9 Ll a5 <br /> =, _NULL <br /> firw t51✓ ._. <br /> t City <br /> County <br /> —r Sari To�Sr ti(r'L. <br /> r APN Book Page Parml I y 52a <br /> ' a J Township Ran e Section (o <br /> ` Latitude 1_�5 L RTH Longitude /311 a(y 08 WEST <br /> DEQ MIN SEC IDEG MIN SEC <br /> LOCATION SKETCH ACTIVITY (=) <br /> NORTH _ NEW WELL <br /> MODiFICATIONIREPAIR <br /> + t � — Other(Specify) <br /> 1 1 <br /> DESTROY ID..elb. <br /> 1 I . V deetGEOLOGICoduras rLOG 1 <br /> PLANNED LYSES (4) <br /> t 1 WATER SUPPLY <br /> ..—. Oom"stic _ Puhlic <br /> F„ F _ Irrigation — Induslrlol <br /> t I pJ MONITORING <br /> TEST WELL <br /> 1 I CATHODIC PROTECTION <br /> t 1 <br /> HEAT EXCHANGE <br /> ` I i DIRECT PUSH T, <br /> tNJECTION <br /> I 1 <br /> VAPOR EXTRACTION <br /> t I <br /> 5PARGING <br /> SOUTH REMEDIATION <br /> Illustrrete ar Dewrilx Diener nI Well Input Rnad.t SWIrlfngsFancTs OTHER(SPECIFY) <br /> erst art(PLur-EASE etc BE ACCiURATE a map U&COMPLETE se addrtionalr <br /> I t <br /> I I <br /> WATER LEVEL & YIELD OF COMPLETED WELL <br /> + I DEPTH TO FIRST WATER (Ft) BELOW SURFACE <br /> 1 t <br /> DEPTH OF STATIC <br /> WATER LEVEL (R)A DATE MEASURED <br /> I <br /> ESTIMATED YIELD (GPM)A TEST TYPE: <br /> TOTAL DEPTH OF BORING (Feet) TEST LENGTH (Hrs)TOTAL DRAWDOWN (R <br /> TOTAL DEPTH OF COMPLETED WELL (Feet) May not be reprerentatirve of a wed's b -tem yield <br /> DEPTH BORE CASING (S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE HOLE TYPE(.!) FROM SURFACE TYPE <br /> DIA. $ MATERIAL! INTERNAL GAUGE SLOT SIZE <br /> CTEN <br /> GRADE DIAMETER OR WALL IF ANY MEFILL FILTER PACK <br /> Ft to FL (Inch") THICKNESS (Inch") FL to R. {`) (TYPEISIZE) <br /> t <br /> I � <br /> i <br /> I <br /> 1 <br /> 1 ATTACHMENTS {_) CERTIFICATION STATEMENT <br /> _ Geologic IN 1,the undersigned,eertity that this report is complete and accurate to the best of my knowledge and belief <br /> — Well Construction Diagram WME 4)CV.�-d 04W Met.Z,41.4 e- CAD, e . <br /> ,... Qeophysicai Log(s) <br /> (PERSON FIRM,OR CORPORATION) (TYPED OR PRINTED) <br /> (� e <br /> oillWater Chorn aly"M I., I U f) 1 �✓ 79- <br /> Other ADDRESS CItY STATE IIP <br /> CJ3 7/ao 9 <br /> ATTACH ADDITIONAL INFORAlATION F IT EXISTS YlELL ORILLEIUAUTH4 D REPRESENTATIVE D SIGN C-51 LICENSE NUMBER <br /> DIVE INA REV 11-0 IF ADDITIONAL SPACE IS NEEDED, USE NEXT CONSECUTIVELY NUMBERED FORM <br />