Laserfiche WebLink
QUADRUPLICATE STATE OF CALIFORNIA DWR USE ONLY — DO NOT FILL IN <br /> For Local Requirements WELL COMPLETION REPORT I L I I I I I I I I_ <br /> Page I of 1 Refer to Instruction Pamphlet STATE WELL NO./STATION NO. <br /> Owner's Well No. 95236 NO.e0368076 I I 1 1:1111 1 1 1 1 1 ❑ <br /> Date Work Began 8/2/2018 Ended8/3/2018I LATITUDE LONGITUDE <br /> Local Permit Agency Environmental Health I I I I I I I I I I I �_ <br /> Permit No. wp0038224 Permit Date 5/8/2018 APN/rRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(✓) -�-VERTICAL —HORIZONTAL —ANGLE (SPECIFY) Name L6 Lagorio Land Co. <br /> DRILLING ROTARY <br /> DEPTH FROM METHOD FLUID Mud Mailing Address 14625 E.Comstock Rd <br /> DESCRIPTION Linden CA 95236 <br /> Ft. to Ft. Describe material, grain, size, color, etc. CITY STATE ZIP <br /> 0 2 Top SoilELL LOCATIO <br /> 2 10 Clay Address 17508 Frazier R <br /> 10 22 Sand City Linden CA 95236 <br /> 22 50 Sand <br /> CountySan Joaquin <br /> APN Book Page Parcel <br /> 50 63 Sand Township Range Section <br /> 63 88 Gravel Latitude I 1 1 <br /> 88 1281 Clay DEG. MIN. SEC. DEG. MIN. SEC. <br /> 128 1331 Gravel LOCATION SKETCH ACTIVITY �) <br /> 133 1371 Clay <br /> NORTH x/ NEW WELL <br /> 137 1391 Sand MODIFICATION/REPAIR <br /> —Deepen <br /> 139 173 Clay —other(Specify) <br /> 173 178 Sand <br /> — DESTROY(Describe <br /> 178 260 Clay Procedures and Materials <br /> Under"GEOLOGIC LOG' <br /> 260 268 Sand PLANNED USES(-) <br /> 268 293 Clay WATER SUPPLY <br /> 293 302 Black Sand Wy _V� Domestic— Public <br /> 302 350 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, 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 <br /> DEPTH OF STATI <br /> WATER LEVEL 1c70 (Ft.)&DATE MEASURED 8/3/2018 <br /> TOTAL DEPTH OF BORING 350 ESTIMATED YIELD • (GPM)& TEST TYPE _ <br /> (Feet) TEST LENGTH—(Hrs.) TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL 310 (Feet) M not be re resentative of a well's long-term yield. <br /> DEPTH BORE- CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE HOLE aTYPE _,!1Q FROM SURFACE TYPE <br /> DIA. MATERIAL/ INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> (Inches) GRADE DIAMETER OR WALL IF ANY FILTER PACK <br /> Ft. to Ft. (Inches) THICKNESS (Inches) Ft. to Ft. MENT TONIT FILL (TYPE/SIZE) <br /> (✓1 (✓—) U <br /> 0 290 105/8 <br /> 290 310 v .045 11 `� RAVEL <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 DRILLINGI C <br /> — Geophysical Log(s) (PERSON,FIRM.OR.CORPOR N) (T3fPED OR PRI D) <br /> — Soil/Water Chemical Analysis 119 Albers Rd Modesto CA 95357 <br /> — Other ADDRESS CITY STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION,IF IT EXISTS. I Signed 08/10/18 668622 <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 />