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WP0037276
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4200/4300 - Liquid Waste/Water Well Permits
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WP0037276
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Entry Properties
Last modified
9/29/2018 11:43:12 PM
Creation date
9/27/2018 2:48:22 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
WP0037276
PE
4366
STREET_NUMBER
11301
Direction
E
STREET_NAME
WEST RIPON
STREET_TYPE
RD
City
RIPON
Zip
95366-
APN
22813040
ENTERED_DATE
9/6/2017 12:00:00 AM
SITE_LOCATION
11301 E WEST RIPON RD
P_LOCATION
99
P_DISTRICT
005
QC Status
Approved
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EHD - Public
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QUADRUPLICATE STATE OF CALIFORNIA DWR USE ONLY NOT FILL IN <br /> For Local Requirements WELL COMPLETION REPORTF17 <br /> Page 1 of 1 Refer to Instruction Pamphlet STATE WELL NO./STATION NO. <br /> Owner's Well No. 95366 No.e0348026 <br /> Date Work Began 7/11/2017 Ended7/12/2017 LATITUDE LONGITUDE <br /> Local Permit Agency Environmental Health I I 1 1 1 1 1 1 11 1 1 1 <br /> Permit No. 77659 Permit Date 6/6/2017 APNITRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(✓) -./—VERTICAL —HORIZONTAL —ANGLE —(SPECIFY) Name John Vrieling <br /> DRILLING ROTARY <br /> DEPTH FROM METHOD IPFLUID Mud Mailing <br /> RS ng Address 23725 S. Frederick CA 95366 <br /> SURFACEDESCRIPTION <br /> Ft. to Ft. Describe material grain, size, color, etc. CITY STATE ZIP <br /> 0 3 Top Soil Address 11301 E West R nl��Cx':�I Ion <br /> 3 8 SandRipon CA 95366 <br /> 8 10 ClayC1ty <br /> 10 14 Sand CountySan Joaquin <br /> APN Book Page Parcel <br /> 14 35 Clay Township Range Section <br /> 35 48 Sand Latitude I I 1 <br /> 48 50 Clay DEG. MIN. SEC. DEG. MIN. SEC. <br /> 50 85 Sand LOCATION SKETCH ACTIVITY ) <br /> 85 97 Clay <br /> NORTH --%/---%/— NEW WELL <br /> MODIFICATION/REPAIR <br /> 97 103 Sand —Deepen <br /> 103 128 Clay —other(Specify) <br /> 128 168 Sand <br /> DESTROY(Describe <br /> 168 240 Clay Procedures and Materials <br /> Under"GEOLOGIC LOG' <br /> 240 263 Sand PLANNED USES() <br /> 263 285 Clay WATER SUPPLY <br /> 285 287 Sand w _-Z Domestic— Public <br /> 287 310 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 /> Illustrate or Describe Distance of Well from Roads, Ruildings, <br /> Fences,Rivera,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 STAT C 7/12/2017 <br /> WATER LEVEL (Ft)&DATE MEASURED <br /> ESTIMATED YIELD (GPM)& TEST TYPE <br /> TOTAL DEPTH OF BORING 310 (Feet) TEST LENGTH—(Hrs.) TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL 270 (Feet) I May not be representative o a well's long-term vield. <br /> DEPTH CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE LHOORLE aTl� _!L FROM SURFACE TYp <br /> DIA. MATERIAL/ INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> (Inches) GRADE DIAMETER OR WALL IF ANY MENT TONT FILLFILTER PACK <br /> FL to Ft. (Inches) THICKNESS (Inches) Ft. to Ft. ✓ (✓) U (TYPE/SIZE) <br /> 0 250 12 <br /> 250 270 .045 186 270VEL <br /> ATTACHMENTS CERTIFICATION STATEMENT <br /> — Geologic Log 1,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,FIROW CORPORAT (TY?X 139 PRINTED) <br /> — Soil/Water Chemical Analysis 119 AIbI? " Modt A 95 7 <br /> — Other ADDRESS ^' CITY STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION,IF IT EXISTS Signed a 97/24/17 668622 <br /> WELL DRILLER/AUTHORIZE RESE TIVE DATE SIGNED C-57 LICENSE NUMBER <br /> DWR 188 REV.11-97 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />
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