Laserfiche WebLink
QUAORUPLICATE STATE OF CALIFORNIA DWR USE ONLY — DO NOT FILL IN <br /> For Local Requirements WELL COMPLETION REPORT <br /> Page 1 of 2 Refer to Instruction Pamphlet STATE WELL NO./STATION NO. <br /> Owner's Well No. 95337 No-e0355241 <br /> Date Work Began 10/5/2017 Ended10/6/2017 _ LATITUDE LONGITUDE <br /> Local Permit Agency Fmtironmental Health I I I I I I I I I <br /> Permit No. 75634 Permit Date 8/30/2016 APNITRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(2) VERTICAL —HORIZONTAL —ANGLE (SPECIFY) Name DeJong Bros. <br /> DRILLING ROTARY <br /> DEPTH FROM METHOD FLUID Mud Mailing Address 22550 Alice Rd <br /> SURFACEDESCRIPTION Manteca CA 95337 <br /> Ft. to Ft. Describe material, grain, size, color, etc. CITY STATE ZIP <br /> 0 3 Top SoilAddress 15218 S.Carrolton WdLOCATIO <br /> 3 8 Sand Cit,Escalon CA 95320 <br /> 8 10 Hard Pan County San Joaquin <br /> 10 13 Sand APN Book Page Parcel <br /> 13 18 Clay Township Range Section <br /> 18 26 Sand Latitude I1 1 <br /> 26 65 Clay DEG. MIN. SEC. DEG. MIN. SEC. <br /> 65 72 Sand LOCATION SKETCH ACTIVITY (✓j <br /> 72 83 Clay <br /> NORTH --V—" NEW WELL <br /> 83 103 Sand MODIFICATION/REPAIR <br /> —Deepen <br /> 103 118 Clay —Other(Specify) <br /> 118 136 Sand <br /> — DESTROY (Describe <br /> 136 184 Clay Procedures and Materials <br /> Under"GEOLOGIC LOG' <br /> 184 188 Sand PLANNED USES() <br /> 188 193 Clay WATER SUPPLY <br /> 193 194 Sand v~) ; Domestic— Public <br /> 194 195 Clay Irrigation — Industrial <br /> 195 199 Sand MONITORING <br /> TEST WELL <br /> — <br /> 199 223 Clay — <br /> ATHODIC PROTECTION- <br /> 223 231 Sand HEAT EXCHANGE- <br /> 231 253 Clay DIRECT PUSH_ <br /> 253 255 Sand INJECTION— <br /> 255 262 Clay VAPOR EXTRACTION <br /> SPARGING <br /> 262 265 Sand SOUTH REMEDIATION— <br /> 265 279 Clay Rlustrare or Describe Distance of Well from Roads, Buildings, <br /> y Fences,Rivers,etc. and attach a map. Use additional paper if OTHER(SPECIFY)_ <br /> 279 281 Sand necessary.PLEASE BE ACCURATE & COMPLETE. <br /> 281 289 Clay WATER LEVEL&YIELD OF COMPLETED WELL <br /> 289 294 Sand DEPTH TO FIRST WATER (Ft.)BELOW SURFACE <br /> 294 330 Clay DEPTH OF STAT C <br /> 330 335 Sand WATER LEVEL �0 (Ft.)&DATE MEASURED 10/6/2017 <br /> TOTAL DEPTH OF BORING 400 ESTIMATED YIELD (GPM)& TEST TYPE <br /> (Feet) TEST LENGTH (Hrs.) TOTAL DRAWDOWN <br /> (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL 360 (Feet) I May not be representative o a well's Ion -term yield. <br /> DEPTH PORECASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE HOLE TYPE ✓> FROM SURFACE TYPE <br /> DIA. Y w a MATERIAL/ INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> Ft. to Ft. (Inches) g O a GRADE DIAMETER OR WALL IF ANY MENT TONI FILL FILTER PACK <br /> m LL (Inches) THICKNESS (Inches) Ft. to Ft. ✓ ✓ ✓ (TYPE/SIZE) <br /> 0 220 20 pLASTIC 12 200 0 56 <br /> 220 360 0 GRAVEL <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 MASELLIS DRILLING INC <br /> — Geophysical Log(s) (PERSON,FIRM,OR CORffREPRE. <br /> ED) <br /> — Soil/Water Chemical Analysis 11 A 7 <br /> Other ADDRESS CITY STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION,IF IT EXISTS. Signe 10/23/17 668622 <br /> 11 WELL DRILLER/AUTHORTIVP DATE SIGNED C-57 LICENSE NUMBER <br /> DWR 188 REV.11-97 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />