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WP0037572
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ESCALON BELLOTA
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4200/4300 - Liquid Waste/Water Well Permits
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WP0037572
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Entry Properties
Last modified
9/29/2018 10:55:48 PM
Creation date
7/24/2018 10:45:55 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
WP0037572
PE
4369
STREET_NUMBER
2700
Direction
S
STREET_NAME
ESCALON BELLOTA
STREET_TYPE
RD
City
FARMINGTON
Zip
95230-
APN
18718010
ENTERED_DATE
11/8/2017 12:00:00 AM
SITE_LOCATION
2700 S ESCALON BELLOTA RD
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
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EHD - Public
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QUADRUPLICATE STATE OF CALIFORNIA DWR USE ONLY — DO NOT FILL IN. <br /> For Local Requirements WELL COMPLETION REPORT F T I I I iI I I I <br /> Page 2 of 2 Refer to Instruction Pamphlet STATE WELL NO./STATION NO. El <br /> Owner's Well No. 95320 NO.e0358711 <br /> Date Work Began 11/14/2017 Ended5/17/2018 LATITUDE LONGITUDE <br /> Local Permit Agency Fnvirnnmpntal Health I I I I I I I I I I I I I <br /> Permit No. wp0037572 Permit Date 11/8/2018 APN/TRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(✓) --/—VERTICAL HORIZONTAL —ANGLE —(SPECIFY) Name C&T Murphy Partners <br /> DRILLING ROTARY <br /> DEPTH FROM METHOD FLUID Mud Mailing Address 1506 Couribywood Dr. <br /> SURFACE DESCRIPTION Escalon CA 95320 <br /> Ft. to Ft. Describe material, grain, size, color, etc. CITY STATE ZIP <br /> 397 400 Shale Address 2700 S. Escalon�e�MA R�TIO <br /> 400 407 Black Sand City Escalon CA 95320 <br /> 407 410 Shale cO1mtySan Joaquin <br /> 410 4181 Black Sand APN Book Page Parcel <br /> 418 4211 Shale Township Range Section <br /> 421 426 Black Sand Latitude I 1 I , _ <br /> 426 431 Shale DEG. MIN. SEC. DEG. MIN. SEC. <br /> 431 467 Black Sand LOCATION SKETCH ACTIVITY (✓) <br /> NORTH --I/— NEW WELL <br /> 467 471 Shale MODIFICATION/REPAIR <br /> 471 495 Black Sand —Deepen <br /> 495 498 Shale —Other(Specify) <br /> 498 500 Black Sand <br /> DESTROY 500 504 Shale Procedures(Describe <br /> 504 520 Black Sand Under"GEOLOGIC LOG" <br /> PLANNED USES() <br /> 520 525 Shale WATER SUPPLY <br /> y N Domestic_ Public <br /> Irrigation — Industrial <br /> ul MONITORING— <br /> TEST WELL <br /> ATHODIC PROTECTION— <br /> HEAT EXCHANGE— <br /> 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 184 (Ft.)&DATE MEASURED 5/17/2018 <br /> ESTIMATED YIELD (GPM)& TEST TYPE <br /> TOTAL DEPTH OF BORING 525 (Feet) TEST LENGTH (Hrs.) TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL 525 (Feet) May not be representative o a well's long-term yield <br /> DEPTH CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE BOE TYPE FROM SURFACE TYPE <br /> DIA. y w o_ MATERIAL/ INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> (Inches) Z a GRADE DIAMETER OR WALL IF ANY MENT T E FILL FILTER PACK <br /> Ft o Ft, m v LL (Inches) THICKNESS (Inches) Ft. to Ft ✓ (✓) U (TYPE/SIZE) <br /> 0 365 24 <br /> 365 525 50 525 <br /> ATTACHMENTS (y> 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 CORPORATI ) (TYPED OR PRINTED) <br /> — Soil/Water Chemical Analysis 119 Albers Rd g Modesto CA 95357 <br /> — Other <br /> ADDRESSa CITY STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION,IF IT EXISTS. Signed 05/22/18 668622 <br /> WELL DRILLER/AUTHOkIZ2g REPRESENTATIVE DATE SIGNED C-57 LICENSE NUMBER <br /> DWR 188 REV.11-97 IFADDITIONAL SPACE IS NEEDED,USE NEXTICONSECUTIVELY NUMBERED FORM <br />
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