Laserfiche WebLink
QUADRUPLICATE STATE OF CALIFORNIA DWR USE ONLY — 00 NOT FILL IN <br /> For Local Requirements WELL COMPLETION REPORT FTI IiIII III I <br /> Page I of I Refer to Instruction Pamphlet STATE WELL NO./STATION NO. <br /> Owner's Well No. 95366 No.e036525 <br /> Date Work Began 3/20/2018 Ended3/23/2018 LATITUDE LONGITUDE <br /> Local Permit Agency Environmental Health _ 1 1 1 1 1 1 1 1 1 1 1 1 <br /> Permit No. Wp0038030 Permit Date 3/9/2018 APWIRSIOTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(✓) -/-VERTICAL —HORIZONTAL —ANGLE —(SPECIFY) Name Scott Baker <br /> DRILLING ROTARY <br /> DEPTH FROM METHOD FLUID MUD Mailing Address 20150 N. Ripon Rd <br /> SURFACEDESCRIPTION Ripon CA 95366 <br /> FL to Ft. Describe material, grain, size, color, etc. CIT' STATE ZIP <br /> 0 3 Top Soil Address 20150 N. Ripon AFNLL LOCATION <br /> 3 18 Sand City Ripon CA 95366 <br /> 18 24 Clay CountySan Joaquin <br /> 24 301 Sand APN Book Page Parcel <br /> 30 581 Clay Township Range Section <br /> 58 801 Sand Latitude I I I <br /> 80 113 Clay DEG. MIN. SEC. DEG. MIN. SEC. <br /> 113 122 Sand LOCATION SKETCH ACTIVITY (✓) <br /> Sand <br /> NORTH --I(— NEW WELL <br /> 122 127 MODIFICATIONIREPAIR <br /> 127 140 Sand —Deepen <br /> 140 186 Clay —Other(Specify) <br /> 186 187 Sand <br /> — DESTROY (Describe <br /> 187 203 Clay Procedures and Materials <br /> 203 209 Sand Under"GEOLOGIC LOG' <br /> PLANNED USES(4) <br /> 209 218 Clay WATER SUPPLY <br /> 218 228 Sand N Domestic— Public <br /> 228 250 Clay Irrigation _ Industrial <br /> MONITORING— <br /> TEST WELL— <br /> ATHODIC PROTECTION— <br /> HEAT EXCHANGE— <br /> DIRECT PUSH_ <br /> INJECTION— <br /> VAPOR EXTRACTION— <br /> SPARGING_ <br /> SOUTH REMEDIATION <br /> lllustrote or Descnbe 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 1 <br /> DEPTH OF STATe, <br /> WATER LEVEL��(Ft.)&DATE MEASURED 3/23/2018 <br /> TOTAL DEPTH OF BORING 250 ESTIMATED YIELD • (GPM)& TEST TYPE <br /> (Feet) TEST LENGTH (Hrs.) TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL 235 (Feet) May not be representative o a well's long-term yield. <br /> DEPTH BORE- CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE HOLE TFROM SURFACE TYPE <br /> DIA. �jjl <br /> MATERIAL I INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> (Inches) GRADE DIAMETER OR WALL IF ANY FILTER PACK <br /> Ft to Ft. MENT TONIT FILL (TYPE/SIZE) <br /> (Inches) THICKNESS (Inches) Ft. to Ft. ✓ ✓ f <br /> 0 195 14 vj I PLASTIC a 2nn 0 106 <br /> 195 235 .045 106 <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 /> — Sal/Water Chemical Analysis 119 Albers Modesto CA 95357 <br /> Other ADDRESS CITY STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION,IFITEXISTS. Signed u 04/03/18 668622 <br /> WELL DRILLER/AUTHORIZED REPRESENTATIVE DATE SIGNED C-57 LICENSE NUMBER <br /> DWR 189 REV.11-97 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />