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t <br /> ORIGINAL STATE OF CALIFORNIA wR USE ONLY — Ro NOT FILL IN <br /> File with DWR WELL COMPLETION REPORT [--1 11 111 1111111- 1 <br /> Page of Refer to Inrtructton Panephlat STATE WELL NOISTATION NO <br /> Owner's Well No NO `603 ; 'I'r. ❑ ❑ <br /> to Work Began � t7� , >wnded fl LATITUDE LONGITUDE <br /> Local Permit Agency r` �c- <br /> Perrrut NO :&V . ._,Permit Date 110 APN/TRS/OTHER <br /> GEOLOGIC LOG <br /> ORIENTATION (�) WELL OWNS <br /> VERTICAL —HORIZONTAL —ANGLE _..,,(SPECIFY) Na]ne J 'L <br /> DRILLING <br /> DEPTH FROM METHOD FLUID Mailing Address 100 Cort <br /> SURFACE DESCRIPTION c{ 7 <br /> FL W Ft Dcscrtbe inaterfal grarn size, calor, etc CITY STATE ZIP <br /> Address-1- E <br /> ddressE CAT I N <br /> Id <br /> e Filly--=�A!LV <br /> r <br /> County r <br /> 1 r APN Book Page Yarocl ! 1 Cao <br /> a Township Ran e�Section <br /> Latitude ORTH >.Ongttude a a WEST <br /> �1f'1 PEO. MIN SEC DEG MIN SEC <br /> e(kYl ti h h LOCATION SKETCH ACTIVITY { ) <br /> NORTH NEW WELL <br /> / MODIFICATIREPAIR <br /> Deepensea <br /> ` r � `j/ <br /> Othor(Specify) <br /> �to <br /> c <br /> _ DESTROY <br /> P+omnd Mat <br /> cdduros Bend Mardad7a <br /> Under 'GEOLOGIC LOG) <br /> r 1 <br /> PLANNED USES (�) <br /> WATER SUPPLY <br /> e r — Domestic — Public <br /> Irrigation , Industrial <br /> r I <br /> r ` MONITORING <br /> TEST WELL <br /> CATHODIC PROTECTION <br /> HEAT EXCHANGE <br /> I I DIRECT PUSH_ <br /> r r INJECTION <br /> VAPOR EXTRACTION <br /> SPARGING <br /> a r SOUTH REMEDIATION <br /> 111e1-itratc or Lkwrihe DLstance of Well ffrpnr Rrxuly Builehow <br /> i I Fencer,R1t.en etc and anaeh a map Use ddrlltl�nal�x�rr It OTHER(SPECIFY) <br /> neeeaaanj PLEASE BE ACCURATE&COMPLETE <br /> r r <br /> r WATER LEVEL & YIELD OF COMPLETED WELL <br /> 1 i DEPTH TO FIRST WATER (FL) BELOW SURFACE <br /> r r DEPTH OF STATIC <br /> e e <br /> WATER LEVEL (Ft)A DATE MEASURED <br /> ESTIMATED YIELD' (GPM)6 TEST TYPE <br /> TOTAL DEPTH OF BORING (Feet) TEST LENGTH (Hes) TOTAL DRAWDOWN (FI) <br /> TOTAL DEPTH OF COMPLETED WELL (Feet) *May not be repiwentame o u welAr long-term tefd <br /> DEPTH CASING (S) <br /> FROM SURFACE HARE T,rpE( . DEPTH ANNULAR MATERIAL <br /> DIA. FROM SURFACE TYPE <br /> (fthes)IA. µ�1 ' MATERIAL 1 INTERNAL GAUGE SLOT SIZE CE BEN <br /> Ft to FL GRADE DIAMETER OR WALL IF ANY MENT TONITE FILL FILTER PACK <br /> (tncr-) THICKNESS (Intlros) FL to FL (=) (=) 0! ) (TYPE/S(ZE) <br /> r <br /> r r <br /> � r <br /> I <br /> e � <br /> I r <br /> ATTACHMENTS (_) CERTIFICATION STATEMENT <br /> Geologic Log I,the undersigned,certify that this report is complete and accurate to the treat of my knowledge and belief <br /> Well Construction Diagram NAME Woo 0 A) 0 N 6-- A,d <br /> _. <br /> Geophysical Log(S) �+(PERSDII FIRM. OR CORPORATIDNI (TYPED DR PRINTED) <br /> �oiVWater Chemical lym V d u!S G <br /> Other ADDRESS J1 CITY STATE Zr <br /> ATTACH ADDITIONAL INFORMATION AT EXISTS Sel71 ' `�� -1.) 6 <br /> WELL DRIlLER1AUFRIZED REPRESENTATIVE DAT SIGNE C-57 LICENSE NUMBER <br /> DWR 188 REV ]I-Vf IF ADDITIONAL SPACE IS NEEDED, USE NEXT CONSECUTIVELY NUMBERED FORM <br />