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WP0038715
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4200/4300 - Liquid Waste/Water Well Permits
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WP0038715
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Entry Properties
Last modified
10/1/2019 11:39:04 AM
Creation date
11/7/2018 8:21:04 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
WP0038715
PE
4366
STREET_NUMBER
0
Direction
S
STREET_NAME
CARROLTON
STREET_TYPE
RD
City
RIPON
Zip
95366-
APN
24507081
ENTERED_DATE
8/28/2018 12:00:00 AM
SITE_LOCATION
S CARROLTON RD
P_LOCATION
05
P_DISTRICT
004
QC Status
Approved
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EHD - Public
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QUADRUPLICATE STATE OF CALIFORNIA DWR USE ONLY — DO NOT FILL IN <br /> For Local Requirements WELL COMPLETION REPORT <br /> Page I of I Refer to Instruction Pamphlet STATE WELL NO./STATION NO. <br /> Owner's Well No. 95358 No-e0369858 I I I I D111 ❑ <br /> Date Work Began 10/8/2018 Endedl0/11/2018 LATITUDE LONGITUDE <br /> Local Permit Agency Frivironmental Heald <br /> w 0038715 8/28/2018 APN/TRS/OTHER <br /> Permit No.� Permit Date <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(✓) -u/—VERTICAL —HORIZONTAL —ANGLE —(SPECIFY) Name Bryan Valencia <br /> DRILLING ROTARY <br /> DEPTH FROM METHOD FLUID Mud Mailing Address P.O. BOX 582007 <br /> SURFACEDESCRIPTION Modesto CA 95358 <br /> Ft. to Ft. Describe material, grain, size, color, etc. CITY STATE ZIP <br /> 0 3 Top Soil Address Carrolton Rd WELL LOCATION <br /> 3 14 Sand Cit,Ripon CA <br /> 14 55 Clay County San Joaquin <br /> 55 67 Sand APN Book Page Parcel <br /> 67 105 Clay Township Range Section <br /> 105 125 Sand Latitude I 1 1 <br /> 125 135 Clay DEG. MIN. SEC. DEG. MIN. SEC. <br /> 135 145 Sand LOCATION SKETCH ACTIVITY ) <br /> NORTH _VL NEW WELL <br /> 145 150 Clay <br /> 150 155 Sand MODIFICATION/REPAIR <br /> —Deepen <br /> 155 1651 Clay —Other(Specify) <br /> 165 182 Shale <br /> DESTROY crie <br /> 182 216 Clay Procedures and Materials <br /> 216 221 Sand Under"GEOLOGIC LOG' <br /> PLANNED USES <br /> 221 236 USES(-(-) <br /> F WATER SUPPLY <br /> 236 244 SandDomestic— Public <br /> 244 300 Clay — Irrigation — Industrial <br /> 300 306 Sand MONITORING— <br /> TEST WELL <br /> 306' 315 Clay 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 1 <br /> DEPTH OF STATLC- <br /> WATER LEVEL (j4 (Ft.)&DATE MEASURED 10/11/2018 <br /> ESTIMATED YIELD ' (GPM)8 TEST TYPE _ <br /> TOTAL DEPTH OF BORING 315 (Feet) TEST LENGTH—(Hrs.) TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL 310 (Feet) Mav not be re resentative o a well's loo -term yield. <br /> DEPTH BORE- CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE HOLE TYPE ✓) FROM SURFACE TYPE <br /> DIA. Y LL a MATERIAL/ INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> (Inches) Z � p of GRADE DIAMETER OR WALL IF ANY MENT TONT FILL FILTER PACK <br /> Ft to Ft. gm v (Inches) THICKNESS (Inches) Ft to Ft. ✓ (20 �) FYPE/SIZE) <br /> 0 290 11 <br /> 290 310 .045 200 310 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,FIRM.OR CORPORATION) (TYPED OR PRINTED) <br /> — SoiWVater Chemical Analysis 119 Albers Rd- Modesto CA 95357 <br /> — Other ADDRESS CITY STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION,IFITE)CISTS. Sgt 10/19/18 668622 <br /> 11 WELL DRILLER/AUTHORIZED REPRESENTATIVE DATE SIGNED C-57 LICENSE NUMBER <br /> DWR 198 REV.11-97 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />
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