Laserfiche WebLink
QUADRUPLICATE STATE OF CALIFORNIA DWR USE ONLY — DO NOT FILL IN <br /> For Local Requirements WELL COMPLETION REPORT <br /> Page I of 1 Refer to Instruction Pamphlel STATE WELL NO./STATION NO. <br /> Owner's Well No. 95320 No-e0365029 <br /> Date Work Began 4/5/2018 Ended4/9/2018 LATITUDE LONGITUDE <br /> Local Permit Agency Environmental Health I I I I I I I I I I I I I <br /> Permit No. WP0038098 Permit Date 3/27/2018 APN/TRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(✓) VERTICAL —HORIZONTAL —ANGLE —(SPECIFY) Name Joe DaSilva <br /> DRILLING ROTARY <br /> DEPTH FROM METHOD FLUID MUD Mailing Address 24197 E. Mariposa Rd ___ <br /> SURFACEDESCRIPTION Escalon CA 95320 <br /> Ft. to Ft. Describe material grain, sLe, color, etc. CITY STATE ZIP <br /> 0 2 Top SoilWE LOCATIO <br /> 2 4 Hard Pan Address 24197 E. Mariposa <br /> City Escalon CA 95320 <br /> 4 13 Clay CountySan Joaquin <br /> 13 181 Sand APN Book Page Parcel <br /> 18 28 Clay Township Range Section <br /> 28 33 Sand Latitude I 1 I <br /> 33 36 Clay DEG. MIN. SEC. DEG. MIN. SEC. <br /> 36 60 Sand LOCATION SKETCH ACTIVITY (✓) <br /> 60 73 Clay <br /> NORTH --I(— NEW WELL <br /> 73 80 Sand MODIFICATION/REPAIR <br /> —Deepen <br /> 80 94 Clay —Other(Specify) <br /> 94 113 Clay <br /> 113 125 Sand — DESTROY <br /> (Describe <br /> °nd Materials <br /> Under"GEOLOGIC LOG' <br /> 125 130 Shale PLANNED USES() <br /> 130 148 Sand WATER SUPPLY <br /> 148 155 Clay W ; Domestic_ Public <br /> 155 158 Sand Irrigation — Industrial <br /> 158 193 Clay MONITORING— <br /> TEST WELL— <br /> 193 203 Sand ATHODIC PROTECTION- <br /> 203 250 Shale HEAT EXCHANGE- <br /> 250 257 Sand DIRECT PUSH- <br /> 257 260 Clay INJECTION_ <br /> 260 278 Sand <br /> VAPOR EXTRACTION— <br /> SPARGING_ <br /> 278 291 Clay SOUTH REMEDIATION— <br /> lllustrme or Describe Distance of ff elifrom Roads, Buildings, <br /> 291 301 Sand Fences,Rivers,etc. and attach a map. Use additional paper if OTHER(SPECIFY)_ <br /> 301 325 Shale necessary. PLEASE BE ACCURATE & COMPLETE. <br /> WATER LEVEL&YIELD OF COMPLETED WELL <br /> DEPTH TO FIRST WATER (Ft.)BELOW SURFACE 1 <br /> DEPTH OF STATIC <br /> WATER LEVEL 1 oo (Ft.)&DATE MEASURED 4/9/2018 <br /> TOTAL DEPTH OF BORING 325 ESTIMATED YIELD ' (GPM)& TEST TYPE <br /> (Feet) TEST LENGTH (Hrs.) TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL 310 (Feet) I May not be representative of a well's long-term yield. <br /> DEPTH BORE- CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE HOLE TYPE FROM SURFACE TYPE <br /> DIA. x w a MATERIAL/ INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> Ft. to Ft. (Inches) g K p a GRADE DIAMETER OR WALL IF ANY ME- TON FILL FILTER PACK <br /> in v (Inches) THICKNESS (Inches) Ft. to Ft. (TYPEISIZE) <br /> 0 250 14 <br /> 250 310 5 110 310 � 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,FI R CORPORA ) (TYPED OR PRINTED) <br /> — Soil/Water Chemical Analysis 11 Aoff °FIM 9 MO 2 CA 95357 <br /> — Other ADDRESS CITY STATE ZIP <br /> ATTACH ADD177ONALINFORMATION,IFfTEXISTS. Signed 04/30/18 668622 <br /> 11 WELL DRILLER/AUTHORIZE {REPRESENTATIVE DATE SIGNED C-57 LICENSE NUMBER <br /> DWR 188 REV.11-97 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />