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t <br />• ORIGINAL STATE OF CALIFORNIA 12WR USEON6y — D <br /> File with DWR WELL COMPLETION REPORT <br /> Page_.Lof__,3, Refer to InsrrucHun PaulNhlet STATE WELL IDN NO <br /> Owner's Well No. S ` ��ta� No. 6034533 Ica " 4r ❑ f ❑ <br /> to Work Began Ended LATITUDE LONGITUDE <br /> Local Pennit Agency v. aL <br /> Permit No —� _> Permit Date IO s APNITRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION (4) V VERTICAL —HORIZONTAL ANGLE —(SPECIFY) Name <br /> Rt-1 I <br /> DRILLING <br /> DEPTH FROM METHOD FLUID M g Addnes5 X05 <br /> SURFACE DESCRIPTION -� <br /> F! to FL Describe material grain S:ze, color, etc STATE ZIP <br /> I W LOCATIq <br /> Address <br /> 1 L 5 City <br /> 1 , <br /> County agelj(in,s <br /> I APN Book Page Plucel 1 Oaf <br /> I r <br /> Townslup,— .5 Ran a RAE Scchorl <br /> Latitude 37 5 NORTH <br /> Longitude-la i ,_a6 wesr <br /> 1 ' DEG MIN 6EC DEG MIN SEC <br /> LOCATION SKETCH ACTIVITY (�) <br /> { , v <br /> NEW WELL <br /> f, p_ MODIFiCATIONIAEPAIA <br /> 1 I — Deepen <br /> Other(SPecay) <br /> I , et <br /> DESTROY(Duenbe <br /> Procedwers and Alarerlars <br /> Under`GEOLooig LOG J <br /> PLANNED USES (2L) <br /> WATER SUPPLY <br /> DOM011 . Public <br /> r r <br /> Ungatim _ Industrial <br /> MONITORING <br /> TEST WELL_ <br /> I I CATHODIC PROTECTION <br /> I HEAT EXCHANGE <br /> 1 r DIRECT PUSH_ <br /> I 1 <br /> INJECTION <br /> r , <br /> VAPOR EXTRACTION <br /> SPARCING <br /> r I <br /> SOUTH <br /> Illrrxtmtr or Ihvcrtlx Dlstm,cr r f SveB fmrn Aarrdr BulfrtArEx REMEDIATION <br /> r t Fences Rill etc and atradl a urapp UUar additional yrryx r if OTHER(SPECIFY) _ <br /> necessary PLEASE BE ACCVRATE it COMPLETE <br /> I e <br /> WATER LEVEL do YIELD OF COMPLETED WELL <br /> r 1 DEPTH TO FIRST WATER (Ft) BELOW SURFACE <br /> I I DEPTH OF STATIC <br /> WATER LEVEL (FL)d DATE MEASURED <br /> ESTIMATED YIELD' {GPM)3 TEST TYPE <br /> TOTAL DEPTH OF BORING {Feet) TEST LENGTH (Hre)TOTAL ORAWDOWNL _(Ft,) <br /> TOTAL DEPTH OF COMPLETED WELL _ ��Feet) 'May not be representative of a Well's los -term yield <br /> DEPTH CASING (S) <br /> FROM SURFACE BORE- � DEPTH ANNULAR MATERIAL <br /> HOLE TYPE(— FROM SURFACE <br /> IDIA <br /> MATERIAL/ INTERNAL GAUGE SLOT SIZE TYPE <br /> CE F1 to FL GRADE DIAMETER OR WALL IF ANY MEIVT[SEN) <br /> EFILLFILTER PACK <br /> (Inches) THICKNESS (Inches) FL t0 Ft (✓' (�) (TYPEtSIZE) <br /> I I <br /> 1 <br /> 1 r <br /> I 1 <br /> 1 1 <br /> I 1 <br /> ATTACHMENTS (t) CERTIFICATION STATEMENT <br /> — Geologic I,the undersigned,Certify that this report Is complete and accurate to the best of my knowledge and belief <br /> Wet!Construohon Diagram NAME �1/�/a W�b ZILI'/^I&— <br /> Geophysical Log(a) FERSON FIRM OR CORPORATION) {TYPED OR PIU,,}}N��W) <br /> SoIVWater Chum I O V �.l. v (//S7-#9- 1i1� %Yf 7 <br /> -A/- Other �11 <br /> ADNESS cay ww STATE IIP <br /> ATTA014 ADDITTOTWL INFORA <br /> �WILL111WA ORIIED REPRESEMATIYE D SIGNmf CENSE NUMBEIP <br /> DWR IhN REV 11 e; IF ADDITIONAL SPACE IS NEEDED, USE NEXT CONSECUTIVELY NUMSERED FORM <br />