Laserfiche WebLink
QUADRUPLICATE STATE OF CALIFORNIA DWR USE ONLY — DO NOT FILL IN <br /> For Local Requirements WELL COMPLETION REPORT <br /> Page I of I Refer to Instruction Pamphlet STATE WELL NO./STATION NO. <br /> Owner's Well No. 95215 No.e0359211 F] <br /> Date Work Began 12/8/2017 Endedl2/12/2017 LATITUDE LONGITUDE <br /> Local Permit Agency Envirianmpntal Hpalth _ <br /> Permit No. wp0037642 Permit Date 11/28/2017 1 APN/rRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(✓) -sL VERTICAL —HORIZONTAL — ANGLE —.(SPECIFY) Name Moormans Water Systems <br /> DRILLING ROTARY <br /> DEPTH FROM METHOD FLUID Mud Mailing Address 2120 Wilcox Rd <br /> DESCRIPTION Stockton CA 95215 <br /> Ft. to Ft. Describe material, grain, size, color, etc. CITY STATE ZIP <br /> 0 3 Top SoilWE I OCATIo <br /> 3 5 ClayAddress 11374 Micke Groveg <br /> City Lodi CA <br /> 5 8 Sand Sand CountySRn Joaquin <br /> 54 58 Sand 8 54 APN Book Page Parcel <br /> 58 73 Clay Township Range Section <br /> Latitude I I 1 <br /> 73 82 Gravel DEG. MIN. SEC. DEG. MIN. SEC. <br /> 82 90 Clay LOCATION SKETCH ACTIVITY (✓) <br /> 90 98 Sand NORTH x' NEW WELL <br /> MODIFICATION/REPAIR <br /> 98 115 Clay —Deepen <br /> 115 123 Sand —Other(Specify) <br /> 123 178 Clay <br /> 178 184 Sand — DESTROY <br /> (Describe trials <br /> Under"GEOLOGIC LOG" <br /> 184 225 Clay PLANNED USES(�c) <br /> 225 228 Sand WATER SUPPLY <br /> 228 232 Clay ai ; -Z Domestic— Public <br /> 232 236 Sand Irrigation — Industrial <br /> 236 238 Clay MONITORING— <br /> TEST WELL- <br /> 238 241 Sand ATHODIC PROTECTION- <br /> 241 2531 Clay HEAT EXCHANGE- <br /> 253 254 Sand DIRECT PUSH_ <br /> 254 263 Clay INJECTION <br /> 263 278 Sand VAPOR EXTRACTION— <br /> SPARGING_ <br /> 278 295 Clay SOUTH REMEDIATION <br /> Illustrate or Describe Distance of Well from Roads, Buildings, <br /> Fences,Rivers,etc. and attach a reap. 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 1 <br /> DEPTH OF STATj� <br /> WATER LEVEL�6 —(Ft.)8 DATE MEASURED 12/12/2017 <br /> ESTIMATED YIELD ' (GPM)& TEST TYPE <br /> TOTAL DEPTH OF BORING 295 (Feet) TEST LENGTH <br /> (Bre.) TOTAL DRAWDOWN (Ft) <br /> TOTAL DEPTH OF COMPLETED WELL 280 (Feet) Mav not be representative o a well's lone-term yield. <br /> DEPTHCASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE B OR E TYPE ✓) FROM SURFACE TYPE <br /> DIA. y W a MATERIAL/ INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> (Inches) Z tr p GRADE DIAMETER OR WALL IF ANY MENT TONT FILL FILTER PACK <br /> Ft. to Ft. ro L) v a (inches) THICKNESS (Inches) Ft to FL ✓ (✓) U (TYPE/SIZE) <br /> 0 260 12 <br /> 260 2801 1 Q45200 2ffl_ V/ GRAVEL <br /> ATTACHMENTS CERTIFICATION STATEMENT <br /> — Geologic Log I,the undersigned,certify that this report is complete and accurate to the beat of my knowledge and belief. <br /> — Well Construction Diagram NAME MASELLIS DRILLING INC, _ - <br /> - Geophysical Log(s) (PERSON,FIRM,OR CORPORATION) (TYPED OR PRINTED) <br /> — Soil/Water Chemical Analysis 119 Albers Rd Modesto CA 95357 <br /> — Other ADDRESS CITY STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION,IF IT EXISTS. 11 Signed 12/13/17 568622 <br /> WELL DRILLER/AUTHORIZED':REPRESENTATIVE DATE SIGNED C-57 LICENSE NUMBER <br /> DWR 188 REV.11-97 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />