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Get CA DWR 188 2006-2024

The free Adobe Reader may be used to view and complete this form. However software must be purchased to complete save and reuse a saved form. File Original with DWR State of California DWR Use Only Do Not Fill In Well Completion Report Page of Owner s Well Number Date Work Began Local Permit Agency Permit Number Refer to Instruction Pamphlet State Well Number/Site Number Click to Get N New Log Number a W No. xxxxxxx Date Work Ended Latitude APN/TRS/Other Permit Date Geologic Log Orientation Vertical to Angle Specify Name Drilling Fluid Depth from Surface Feet Well Owner Horizontal Drilling Method Mailing Address Description Longitude City Describe material grain size color etc State Zip Well Location Address County Deg. Datum Min* Sec* Dec Lat. Dec Long. APN Book Parcel Township Range Section Location Sketch Activity Sketch must be drawn by hand after form is printed* New Well Modification/Repair Deepen Other Destroy North Describe procedures and materials under GEOLOGIC LOG West East Planned Uses Water Supply Domestic Public Irrigation Industrial Cathodic Protection Dewatering Heat Exchange Injection Monitoring Remediation Sparging Test Well Vapor Extraction South Illustrate or describe distance of well from roads buildings fences rivers etc* and attach a map* Use additional paper if necessary. Please be accurate and complete. Water Level and Yield of Completed Well Total Depth of Boring Depth to first water Feet below surface Depth to Static Feet Date Measured Water Level Estimated Yield GPM Test Type Test Length Hours Total Drawdown May not be representative of a well s long term yield. Casings Depth from Surface Feet to Feet Borehole Diameter Inches Type Material Annular Material Wall Outside Thickness Diameter Screen Attachments Well Construction Diagram Geophysical Log s Soil/Water Chemical Analyses Attach additional information if it exists. DWR 188 REV. 1/2006 Slot Size if Any Fill Certification Statement I the undersigned certify that this report is complete and accurate to the best of my knowledge and belief Person Firm or Corporation CA Signed C-57 Licensed Water Well Contractor Date Signed C-57 License Number IF ADDITIONAL SPACE IS NEEDED USE NEXT CONSECUTIVELY NUMBERED FORM Reset Form. Datum Min* Sec* Dec Lat. Dec Long. APN Book Parcel Township Range Section Location Sketch Activity Sketch must be drawn by hand after form is printed* New Well Modification/Repair Deepen Other Destroy North Describe procedures and materials under GEOLOGIC LOG West East Planned Uses Water Supply Domestic Public Irrigation Industrial Cathodic Protection Dewatering Heat Exchange Injection Monitoring Remediation Sparging Test Well Vapor Extraction South Illustrate or describe distance of well from roads buildings fences rivers etc* and attach a map* Use additional paper if necessary. Please be accurate and complete. Water Level and Yield of Completed Well Total Depth of Boring Depth to first water Feet below surface Depth to Static Feet Date Measured Water Level Estimated Yield GPM Test Type Test Length Hours Total Drawdown May not be representative of a well s long term yield. .

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