Laserfiche WebLink
QUADRUPLICATE STATE OF CALIFORNIA ��..���QWR USE ONLY — DO NOT FILL IN <br /> For Local Requirements WELL COMPLETION REPORT l i l i i I I l <br /> Page I of I Refer to Instruction Pamphlet STATE WELL NO.I STATION N0. <br /> Owner's Well No. 95320 No,e0341704 ❑ El <br /> Date Work Began Ended5/12/2017 LATITUDE LONGITUDE <br /> Local Permit Agency Environment;al_Health <br /> Permit No. Permit Date <br /> 77189 4/11/2017 1APNrrRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(✓) VERTICAL HORIZONTAL — ANGLE (SPECIFY) Name Henry Vandepol <br /> DRILLING Y ROTAR <br /> DEPTH FROM METHOD FLUID Mud Mailing Address 16972 Sexton Rd <br /> SURFACEDESCRIPTION Escalon CA 95320 <br /> Ft. to Ft. Describe material, grain, size, color, etc. CITY STATE ZIP <br /> 0 3 Top SoilAddress 16475 S. Brenn n%&LOCATION <br /> 3 10 Hard Pan City Escalon CA 95320 <br /> 10 20 Sand CountySan Joaquin <br /> 20 43 Clay APN Book Page Parcel <br /> 43 48 Sand Township Range Section <br /> 48 64 Clay Latitude I 1 <br /> 64 68 Sand DEG. MIN. SEC. DEG. MIN. SEC, <br /> 68 85 Clay LOCATION SKETCH ACTIVITY L) <br /> NORTH _3(_ NEW WELL <br /> 85 94 Gravel MODIFICATION/REPAIR <br /> 94 112 Clay —Deepen <br /> 112 132 Gravel —Other(Specify) <br /> 132 142 Sand <br /> 142 198 Clay — DESTROY (Describe at gala <br /> 198 200 Sand Under"GEOLOGIC LOG' <br /> PLANNED USES() <br /> 200 213 Clay ~ WATER SUPPLY <br /> 213 218 Sand u) Domestic — Public <br /> 218 258 Clay Irrigation _ Industrial <br /> 258 265 Sand MONITORING— <br /> TEST WELL_ <br /> 265 335 Clay ATHODIC PROTECTION- <br /> 335 338 Coarse Sand HEAT EXCHANGE- <br /> 338 382 Clay DIRECT PUSH_ <br /> 382 390 Sand INJECTION— <br /> VAPOR EXTRACTION— <br /> 390 445 Clay SPARGING_ <br /> SOUTH REMEDIATION <br /> Illustrate or Descnbe 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 STAT C <br /> WATER LEVEL- (Ft.)&DATE MEASURED 5/1/2017 <br /> TOTAL DEPTH OF BORING 445 ESTIMATED YIELD • (GPM)& TEST TYPE <br /> (Feet) TEST LENGTH (Hrs.) TOTAL DRAWDOWN <br /> (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL 400 (Feet) IMay not be representative o a well's lon -term yield. <br /> DEPTH CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE <br /> BORE FROM SURFACE TYPE <br /> DIA. �TYPE <br /> MATERIAL/ INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> (Inches) GRADE DIAMETER OR WALL IF ANY MENT TONIT FILLFILTER PACK <br /> Ft. to Ft. (Inches) THICKNESS (Inches) Ft. to Ft. (TYPE/SIZE) <br /> 0 320 14 <br /> 320 360 ✓ GRAVEL <br /> 360 380 <br /> 380 400 <br /> ATTACHMENTS (✓ ) CERTIFICATION STATEMENT <br /> — Geologic Log 1,the undersigned,certify that this report is complete and accurate to the best of my knowledge and belief. <br /> — Well Construction Diagram NAME MASELLAS DRILLIN C <br /> Geophysical Log(s) (PERSON, Rtt±)TED) <br /> — SoillWater Chemical Analysis 119 Albers <br /> — Other ADDRESS CITY STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION,IF IT E)CISTS. Signed 05/12/17 668622 <br /> WELL DRILLERIAUTHORIZED REPRESENTATIVE DATE SIGNED C-57 LICENSE NUMBER <br /> DWR 188 REV.11-97 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />