Laserfiche WebLink
ORIGINAL STATE OF CALIFORNIA —QWR USE LY T It N <br /> File With DWR WELL COMPLETION REPORT <br /> Page!Of.,?_� Refer to Instruction Pamphlet STATE WELL NOiSTATION NO <br /> Owner's Well No av4 ;' No. ie�$4539,x.F Y s �; <br /> Work Began L� , End d ((� o )ap45 y I LATITUDE ❑ LONGITUDE <br /> r. <br /> Stcal Permit Agency �u <br /> Permit No ' Permit Date f0 Co �= APNtTRS/OTHER <br /> GEOLOGIC LOG ! WELL OWNER <br /> ORIENTATION (�) VERTICAL _HORIZONTAL —ANGLE _(SPECIFY) Name u'rp <br /> DRILLINGfo <br /> DEPTH FROM METHOD FLUID Mai ng Address 4 <br /> SURFACE DESCRIPTION it 70 <br /> FL to Ft Describe inatertal,grain size,color, etc CITY v STATE: ZIP <br /> o�ra5' 6R-&LL- Address 41 WE LOCATI ✓ <br /> t z S Clty <br /> a62 u� <br /> Caanty >2 <br /> ' I 5 APN BookPage Parcel a 1'41 �,0� <br /> Township Za S Range R�Seaton <br /> C Lahtude EG MON ,?-NORTH Longitude iZ1 I� O WEST <br /> C <br /> LOCATION SKETCH ACTIVITY (=) <br /> I t <br /> NORTH NEW WELL <br /> ' I MODIFICATI eEPAIR <br /> — Deepen <br /> I + — Other(Spacity) <br /> DESTROY(Describe <br /> + i Procedures and AlaII <br /> Under'GEOLOGIC LOG) <br /> I PLANNED USES { ) <br /> WATER SUPPLY <br /> 1 I <br /> Domestic — PUNIC <br /> I 1 - Irrlgshon - Industrlel <br /> I t MONITORING <br /> TEST WELL <br /> + CATHODIC PROTECTION <br /> 1 t HEAT EXCHANGE..,._ <br /> DIRECT PUSH_ <br /> ENJECTION..� <br /> ' VAPOR EXTRACTION <br /> t t <br /> SPARGING <br /> I I 1111cvtmte or Describe DUtasO i f Well front Rnn(ir 8inklin is REMEOIATII <br /> + I <br /> Fancies Rhin sic and attach a map Use OTHER{SPECIFY) <br /> necesmnJ PLEASE BE ACCOUTE&COMPLETE <br /> I 1 <br /> WATER LEVEL & YIELD OF COMPLETED WELL <br /> DEPTH TO FIRST WATER (Ft) BELOW SURFACE <br /> I t DEPTH OF STATIC <br /> WATER LEVEL (Pt)a DATE MEASURED <br /> ESTIMATED YIELD (GPM)a TEST TYPE <br /> TOTAL DEPTH OF BOLTING _ !Feet) TEST LENGTH (Mrs)TOTAL DRAWDOWN , (Ft) <br /> TOTAL DEPTH OF COMPLETED WELL (Feet) 'M not be representative of a well t!an -term reW <br /> DEPTH BORE CASING (S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE HOLE TYPE( FROM SURFACE TYPE <br /> (��) �, MATERIAL I INTERNAL GAUGE SLOT SITE C:E?�)r <br /> FTO"ENFTE <br /> Ft to Ft `` GRADE DIAMETER OR WALT IF ANY MFlLL FILTER PACK <br /> THICKNESS (Inches) FL to Ft ( { LL (TYPEISIZE) <br /> t t <br /> 1 <br /> 1 t <br /> I <br /> 1 I <br /> t <br /> ATTACHMENTS CERTIFICATION STATEMENT <br /> _ Geologic Lop I,the undersigned,certify that this report is complete and accurate to the gest of my knowledge and belief <br /> — Well Construction Diagram NAME "�/T/'•'v&1AWS <br /> GoophyskalLop(8) IPERSCK FIRM OR CORPORAT50N) (IYKD R PRINTED) <br /> SOiVWater Chemka//l��Analyses <br /> JzOM,er. �i1_1`yIQ Q3U12C ADDRESS CrrY STATE ZIP <br /> ATTACH AOD1TrC1YgL INFOI y70I IF ff EXISTS S pd WELL CRILLER/AUTHORIIED REPRESEItTATIVE DALE SIGNED C 57 LICENSE NUMBER <br /> DWR TNR REV 11.97 IF ADDITIONAL SPACE IS NEEDED, USE NEXT CONSECUTIVELY NUMBERED FORM <br />