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WP0037793
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4200/4300 - Liquid Waste/Water Well Permits
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WP0037793
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Entry Properties
Last modified
9/29/2018 10:53:24 PM
Creation date
5/17/2018 11:40:07 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
WP0037793
PE
4369
STREET_NUMBER
26192
Direction
N
STREET_NAME
MACKVILLE
STREET_TYPE
RD
City
CLEMENTS
Zip
95227-
APN
02116042
ENTERED_DATE
1/11/2018 12:00:00 AM
SITE_LOCATION
26192 N MACKVILLE RD
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
Scanner
DAfonskaia
Supplemental fields
CYEAR
2018
Tags
EHD - Public
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`QUADRUPLICATE STATE OF CALIFORNIA DWR USE ONLY — DO NOT FILL IN <br /> For Local Requirements WELL COMPLETION REPORT <br /> Page 2 of 2 Refer to Instruction Pamphlet STATE WELL NO./STATION NO. <br /> Owner's Well No. 95227 NO.e0366510 ❑ ❑ <br /> Date Work Began 5/4/2018 Ended5/8/2018 LATITUDE LONGITUDE <br /> Local Permit Agency Environmental Health I I I I I I I I I I I <br /> Permit No. wp0037793 Permit Date 1/12/2018 APN/TRSIOTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(!) L VERTICAL —HORIZONTAL —ANGLE —(SPECIFY) Name Biglieri Farms <br /> DRILLING ROTARY <br /> DEPTH FROM METHOD FLUID Mud Mailing Address P. O. BOX 604 <br /> DESCRIPTION Clements CA 95227 <br /> Ft. to Ft. Describe material, grain, size, color, etc. CITE STATE ZIP <br /> 357 387 Black Sand 26192 N. Mackvllle KdLOCATIo <br /> 387 395 White ClayAddress _ <br /> City Clements CA 95227 <br /> 395 405 Blue Clay CountySan Joaquin <br /> 405 409 Sand APN Book Page Parcel <br /> 409 415 Blue Shale Township Range Section _ <br /> 415 423 Grey Shale Latitude I 1 1 <br /> 423 472 Blue Clay DEG. MIN. SEC. DEG. MIN. SEC. <br /> 472 483 Black Cla LOCATION SKETCH ACTIVITY (✓) <br /> 483 495 Brown Shale NORTH NEW WELL <br /> 495 500 Green Clay MODIFICATION/REPAIR <br /> —Other(Specify) <br /> DESTROY (Describe <br /> Procedures and Materials <br /> Under"GEOLOGIC LOG' <br /> PLANNED USES() <br /> WATER SUPPLY <br /> y Domestic— Public <br /> Q Irrigation Industrial <br /> u] MONITORING— <br /> TEST WELL— <br /> ATHODIC PROTECTION— <br /> HEAT EXCHANGE—... <br /> DIRECT PUSH_ <br /> INJECTION— <br /> VAPOR EXTRACTION—_ <br /> SPARGING <br /> SOUTH REMEDIATION <br /> OTHER(SPECIFY) <br /> — <br /> lllustrate or Describe Distance of Well from Roads, Buildings, <br /> Fences,Rivers,etc. and attach a map. Use additional paper if — <br /> necessary. PLEASE BE ACCURATE & COMPLETE. <br /> WATER LEVEL&YIELD OF COMPLETED WELL <br /> DEPTH TO FIRST WATER (FL)BELOW SURFACE <br /> DEPTH OF STATIC <br /> WATER LEVEL 161 (Ft.)&DATE MEASURED 5/8/2018 <br /> ESTIMATED YIELD ' (GPM)& TEST TYPE <br /> TOTAL DEPTH OF BORING 500 (Feet) TEST LENGTH <br /> TOTAL DEPTH OF COMPLETED WELL4OO (Hrs.) TOTAL DRAWDOWN (Ft.) <br /> ��t) May not be representative o a well's long-term yield. <br /> DEPTH CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE BORE TYPE ✓ FROM SURFACE <br /> HOLE L TYPE <br /> DIA. Y w a MATERIAL/ INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> (Inches) Z w O a GRADE DIAMETER OR WALL IF ANY MENT TONIT FILL FILTER PACK <br /> Ft. to Ft. m N v LL (Inches) THICKNESS (Inches) Ft. to Ft. ✓ ✓) U (TYPE/SIZE) <br /> 0 300 20 v STPPI 12 1M 0 50 ✓ <br /> 300 400 50 400 GRAVEL <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,FIRM,OR CORPORATION) (TYPED OPRINTED) <br /> — Soil/Water Chemical Analysis 119AIbersRdS CA 95357 <br /> — Other ADDRESS itCITY STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION,IF IT EXISTS. Signed " 06/04/18 668622 <br /> WELL DRILL "HOIZ�ff, PRESE TIVE DATE SIGNED C-57 LICENSE NUMBER <br /> DWR 188 REV.11-97 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />
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