Laserfiche WebLink
QUADRUPLICATE STATE OF CALIFORNIA DWR USE ONLY — DO NOT FILL IN <br /> For Local Requirements WELL COMPLETION REPORT <br /> Page 1 of I Refer to Instruction Pamphlel �— STATE WELL NO./STATION NO. <br /> Owner's Well No. 95366 NO.e0337044 I 1 I— D❑ F] <br /> Date Work Began 3/2/2017 Ended3/6/2017 LATITUDE LONGITUDE <br /> Local Permit Agency Enylionmental HeaIth I 1 I I I I I I I I I I I <br /> 76747 2/8/2017 APN/TRS/OTHER <br /> Permit No. Permit Date <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(✓) �L VERTICAL __HORIZONTAL ANGLE (SPECIFY) Name Charles Fields <br /> DRILLING ROTARY <br /> DEPTH FROM METHOD FLUID Mud Mailing Address 21602 S. Carrolton Rd <br /> RF DESCRIPTION Ripon CA 95366 <br /> Ft. to Ft. Describe material, grain, size, color, etc. CITY F�,I, STATE ZIP <br /> 0 2 Top Soil Address 21422 S Carrolt n KU— LOCATION <br /> 2 19 Sand City Ripon CA 95366 <br /> 19 64 Clay <br /> County San Joaquin <br /> 64 68 Sand APN Book Page Parcel <br /> 68 80 Clay Township Range Section <br /> 80 84 Sand Latitude I I <br /> 84 113 Clay DEG. MIN. SEC. DEG. MIN. SEC. <br /> 113 124 Sand LOCATION SKETCH ACTIVITY (✓) <br /> NORTH --V—" NEW WELL <br /> 124 158 Clay <br /> MODIFICATION/REPAIR <br /> 158 160 Sand —Deepen <br /> 160 161 Clay —other(Specify) <br /> 161 164 Sand <br /> 164 170 Clay — DESTROY <br /> and Matrials <br /> Under"GEOLOGIC LOG' <br /> 170 175 Sand PLANNED USES() <br /> 175 186 Clay WATER SUPPLY <br /> 186 188 Sand to F —sL Domestic — Public <br /> 188 219 Clay <br /> Irrigation _ Industrial <br /> uJ <br /> 219 222 Sand MONITORING <br /> TEST <br /> 223 ClayTEST WELL_ <br /> ATHODIC PROTECTION- <br /> 223 224 Sand HEAT EXCHANGE- <br /> 224 250 Clay DIRECT PUSH— <br /> INJECTION <br /> VAPOR EXTRACTION— <br /> SPARGING— <br /> SOUTH REMEDIATION— <br /> Illustrate or Describe Distance of Well from Roads, Buildings, <br /> Fences,Rivers,etc. and attach a map. Use additional paper if OTHER(SPECIFY)_ <br /> necessary. PLEASE BE ACCURATE & COMPLETE. <br /> WATER LEVEL&YIELD OF COMPLETED WELL <br /> DEPTH TO FIRST WATER (Ft.)BELOW SURFACE <br /> DEPTH OF STATIC <br /> WATER LEVEL 44 (Ft.)&DATE MEASURED 2/17/2017 <br /> ESTIMATED YIELD ' (GPM)& TEST TYPE <br /> TOTAL DEPTH OF BORING 250 (Feet) TEST LENGTH (Hrs.) TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL 230 (Feet) I May not be representative of a well's long-term yield. <br /> DEPTH CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE BORE- Ty ✓) FROM SURFACE TYPE <br /> DIA Y w a MATERIAL I INTERNAL GAUGE SLOT SIZE CE- IEN- <br /> Ft. to Ft. (Inches) g Uj p a GRADE DIAMETER OR WALL IF ANY MENT TONIT FILL FILTER PACK <br /> m 0 - (Inches) THICKNESS (Inches) Ft. to Ft. ✓ (✓) (') (TYPE/SIZE) <br /> 0 210 12 <br /> 210 230 E <br /> ATTACHMENTS CERTIFICATION STATEMENT <br /> — Geologic Log I,the undersigned,certify that this report is complete and accurate to the best of my knowledge and belief. <br /> — Well Construction Diagram NAME MASELLIS DRILLING INC <br /> — Geophysical Log(s) (PERSON,FIR OR CORPORATI N) (TYPED OR PRINTED) <br /> — SoilfWater Chemical Analysis 11 • AMnripsto CA 95357 <br /> — Other ADDRESSCITY STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION,IF IT EXISTS. Signed 03/06/17 668622 <br /> WELL DRILCMAUTHCrRIW2ES A DATE SIGNED C-57 LICENSE NUMBER <br /> DWR 188 REV,11-97 IF ADDITIONAL SPACE IS NEEDED,USE N ONSEC TIVELY NUMBERED FORM <br />