Laserfiche WebLink
QUADRUPLICATE STATE OF CALIFORNIA <br />For Local Requirements WELL COMPLETION REPORT <br />Page 1 of 1 Refer to Instruction Pamphlet <br />Owner's Well No. 95215 No. e0368078 <br />Date Work Began 7/26/2018 , Ended7/30/2018 <br />Local Permit Agency Environmental Health <br />Permit No. wp0038479 Permit Date 6/25/2018 <br />GEOLOGIC LOG <br />DWR USE ONLY — DO NOT FILL IN <br />STATE WELL NO./ STATION NO. <br />El <br />LATITUDE LONGITUDE <br />[1—A I I I I I I I I_ <br />APN/TRS/OTHER <br />WELL OWNER <br />ORIENTATION (✓) <br />DEPTH FROM <br />SURFACEDESCRIPTION <br />FL to Ft <br />—,'— VERTICAL <br />DRILLING ROTARY <br />METHOD <br />Describe <br />— HORIZONTAL — ANGLE —(SPECIFY) <br />FLUID Mud <br />material, grain, size, color, etc. <br />Name Jim hall <br />ANNULAR MATERIAL <br />Mailing Address 18301 E. Gawne Rd <br />Stockton <br />_ <br />CA 95215 <br />CITY <br />Address 18301 E. GawneW1, LOCATION <br />STATE ZIP <br />0 3 Top Soil <br />336 <br />0 220 <br />Clay <br />v PLASTIC <br />City Stockton CA 95215 <br />0 54_ <br />36 <br />42 <br />Sand <br />County San Joaquin <br />42 <br />58 <br />Clay <br />APN Book Page Parcel <br />Township Range Section <br />Latitude I <br />DEG. MIN. SEC. <br />LOCATION SKETCH <br />NORTH <br />v~i <br />� <br />SOUTH <br />Illustrate 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 />I I _ <br />DEG. MIN. SEC. <br />ACTIVITY V) — <br />--V—"NEW WELL <br />MOMFICATION/REPAIR <br />— Deepen <br />— other (Specify) <br />OY <br />— PErocced res (Describe and Materials <br />Under "GEOLOGIC LOG' <br />PLANNED USES() <br />WATER SUPPLY <br />y Domestic — Public <br />Irrigation _ Industrial <br />� <br />MONITORING — <br />TEST WELL_ <br />ATHODIC PROTECTION - <br />HEAT EXCHANGE - <br />DIRECT PUSH__ <br />INJECTION <br />VAPOR EXTRACTION — <br />SPARGING _ <br />REMEDIATION — <br />OTHER (SPECIFY)— <br />58 65 Sand <br />65 142 Clay <br />142 148 Sand <br />148 192 Clay <br />192 198 Sand <br />198 218 Clay <br />218 221 Sand <br />221 229 Clay <br />229 230 Sand <br />230 240 Clay <br />240 246 Gravel <br />246 308 Clay <br />308 311 Black Sand <br />311 322 Clay <br />322 325 BlaCK Sand <br />325 334 Clay <br />334 335 Black Sand <br />335 368 Shale <br />368 369 Black Sand <br />369 415 Clay <br />WATER LEVEL & YIELD OF COMPLETED WELL <br />DEPTH TO FIRST WATER (Ft.) BELOW SURFACE <br />DEPTH OF STATIC 28 7/30/2018 <br />WATER LEVEL (FL) & DATE MEASURED _. <br />ESTIMATED YIELD (GPM) & TEST TYPE <br />TEST LENGTH (Hrs.) TOTAL DRAWDOWN (Ft.) <br />May not be representative o a well's long-term yield. <br />-OTAL DEPTH OF BORING 415 (Feet) <br />'OTAL DEPTH OF COMPLETED WELL 340 (Feet) <br />DEPTH <br />FROM SURFACE <br />O <br />HOLE <br />DIA. <br />(Inches) <br />CASING (S) <br />DEPTH <br />FROM SURFACE <br />ANNULAR MATERIAL <br />TYPE ✓ ) <br />Y w o MATERIAL / <br />g U U a GRADE <br />m N LL <br />INTERNAL GAUGE SLOT SIZE <br />DIAMETER OR WALL IF ANY <br />(Inches) THICKNESS (Inches) <br />TYPE <br />CE- BEN - <br />MENT TONI FILL FILTER PACK <br />✓ (� �) (TYPE/SIZE) <br />Ft. to Ft. <br />Ft. to Ft. <br />0 220 <br />14 <br />v PLASTIC <br />A 7nn <br />0 54_ <br />220 340 <br />`� 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 OR PRINTED) <br />— SoillWater Chemical Analysis 119 Albers Rd �Modesto CA 95357 _ <br />— Other ADDRESS CITY STATE ZIP <br />ATTACH ADDITIONAL INFORMATION,IFITEXISTS. Sigma 08/03/18 668622 <br />WELL DRILLER/AUTHORIZED REPRESENTATIVE DATE SIGNED C57 LICENSE NUMBE <br />DWR 188 REV. 11-97 IF ADDITIONAL SPACE IS NEEDED, USE NEXT CONSECUTIVELY NUMBERED FORM <br />