GW1-2021-03769_Well Construction - GW1_20210823

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WELL cpjx R.'f,,T�T)[U1V RECORI3 fiGW 1iti i~trr)neerrlai vac nty:
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2•Well Conetrneitna Permit a-
J.lrfaH nPPlftnbht tva$Cp7it►Jnellull1MrAtrrr(I r IN,OWN),809,r/orrmrrR rtcJ
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i•NMI Use(check well usr):
WaterSupplywen: ? stm
Agrlcultutal DmettlelpaUPuhlic tot.
Crcothcrmal(1.1"Tiug/Coot)ng Supply) Residential Witter SUPPLY(single)
IndwirialMommeraiai Residcntial WAW Supply(sltanxl) e
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tcr�tgrply �tin ell:Recbat(tc �frrnmdwatcrttctnrdisliunr Storage:and Rcoovery 133alinity RAW" AL
r Tcsl �Stormwater Dminagsnenroi i¢ctntotttgy �5ubsidcncr Cotnml
etmal(Closer!Loop) �19•rhactt 1»At(Hearin tro(ln Rctum ()#tier lain under$21 Reme ts) it. ra
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A, LP-Q I 1 1 Well 1At1
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rttysienl nddrose,C1ty,nnA 2.ip • t' ••�
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Loamy rateel tdernideation Nn.(Prh') -km
51/.Mi ilndt,aMl longitude in degtties/mInllte0ftelinds or dceimal degrem
W-11 field,ane lnMang in nidlrorant) 0 1 7,Ce
-2W 53 �l� Lo -aA.la(atc)theweil(A) tl'crmanrnt or Orfet>1(!n�ry
jrjr.rl}7fm$rP'R -.1 haMl v Mr11Y dear lhr:twd"MW Ravi rmrnnr mW a aeennlarrtr
7.i:,this it art:palr to an esiAdng welt: InXes or al4a udN+!SA W"'W.;n2C.#1h0 or 1.1A NC.tC a2C,.O.2W Wert C.WrMc»ntr Strmdartla—1 rhar a
4-rhi•ixarepntr,,pllmprkmitm lea consinralonbfomattanmri nmprr_arrrnrrgfrha rnPvoftrtlofYmrrlNns7+tlq/1mgdml*the W41Meer.
P-7-Ir-derVtrcfflaPcscep01,rJro7lrMhardofrhlrfaml. ?,&sft diagnmoradtldo=tWOdcMWA'
R,6Q1'Ge011rahe/111PT or Ciaiwd-1 onp Geothermal Welb hllvingthe same Yau mays use the bWA of tbuapage to prdvlde adMonnl well title dtMAIA or well
1-ris nretinn,only I OW.1 4A necdctr. r1letimm TOTAL NUMBER of+rrllc C'Mmuetina tirtails, You am alm MMh addillonel puga if aliewarv.
driliad:-_.•.._.
etal well tteptAhaimv Israel surlitec: _(R:124bk. t+�r Mi We11a: Submit this farm t,.4(Mn 30 dMw of camplstion of well
inrmrrloplcwnllrJitrnrlAeigrtrifdlQrtrngr(Fxamplu^ eT/1(P'a+td i 10A7 eonowli0tiln the rdlowbit.
Lit-States:Water levy below top of easing: (R.} rpWaoo of Water Ratmtreml,lafarmatlon Proeeaft llinll,
1f,mlr.rltnrd la aMna tmYng,vie _ 1617&W Sewlee Center,FkIdg6.TIC 274"-1617
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11_r rehotedtatueter; o p1a�.)n 24N Par/nMctillN hn sdditlwn to beading Ox foM ro the nddIM In 24a
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l�Well conatrnetlon method. l [ � y qW 4ubmh one copy of this farm+rllhtn 30 days of eotnptdlmt of wen
t conM tion to the forinarit1W
(i a,etgy:•,mtnry-rlthlc,41Md T ttslt.ct0
Dlvlslnn of Wntt:r Reantivu%Underground tr jettlan Canirrol flragrom,
t WATER SUPPF 1J WRI.LS oNl,1f: ifi3K Mn11 SgNroe Centerr RA
t1 Yn r t tcigkt WC 7.117J9••iGib
134.Yictd(RPM) t ._ " uu1 of teAP. . Roe arm W"tor Snlnlely&in HO R►tlise In'addition to widing the ram to
�j the nddress(cs) libove, also suhpait one copy of Iht9 tams allMht 30 days of
tan.DrstptcctMq tppe¢ ,Amvrmt^, o � completion of Well n m ft,cmmn Inalm 4MM1MIt of the tanlnly
Where con9ttr culcl.
Ward linn racwtmant art?-1,;tnmcnm7 Qmilty-rAvon nor Water tt o nram
t2�seatz xl m1a

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Well Driller Self-Grout Certificati0A
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Owner �io Qa60SOIr" New Well:
AddressA'C5I I\A n CA(VAA 116,gepair:
Permit: MCXI(57 ftt l l ;.)C �-
I hereby certify that the above referenced well was grouted in appearancein accordance with
all County Well rules.
Well Dxs7ler X �`�e�Ga�v� 1 g•
Certificate#: Z 1 Date Grouted: LO "Z- l
Construction: Grout.
Total Depth: :30 S Type- CE rV-P-- -
Casing Type: -)N G Thidmess: C`l'"j
Casing Depth: Depth: 2�
Diameter: t 0 Fl
Weight/Thick
Height:
Drive Shoe:
GPM.—[
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