Laserfiche WebLink
QUADRUPLICATE STATE OF CALIFORNIA DWR USE ONLY — DO NOT FILL IN <br /> For Local Requirements WELL COMPLETION REPORT <br /> Page 1 of I Refer to Instruction Pamphlet STATE WELL NO.I STATION NO. <br /> Owner's Well No. 95320 No.e0369859 <br /> Date Work Began 9/28/2018 Ended10/1/2018 LATITUDE LONGITUDE <br /> Local Permit Agency Environmental Health _ I I I I I i I I I i i I <br /> Permit No. wp0038757 Permit Date 9/10/2018 APN/rRSIOTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(!) –+L VERTICAL —HORIZONTAL — ANGLE (SPECIFY) Name Steven Beard <br /> DRILLING <br /> DEPTH FROM METHOD ROTARY FLUID Mud Mailing Address 17495 Seidner Rd <br /> SURFACE <br /> DESCRIPTION Escalon CA 95320 <br /> Ft. to Ft. Describe material, grain, size, color, etc. CITY STATE ZIP <br /> 0 3 Top Soil Address 17349 Seidner Ind LL LOCATION <br /> 3 54 Sand City Escalon CA 95320 <br /> 54 72 Clay CountySan Joaquin <br /> 72 91 Sand APN Book Page Parcel <br /> 91 123 Clay Township Range Section <br /> 123 151 Shale Latitude 1 1 1 <br /> 151 164 Clay DEG. MIN. SEC. DEG. MIN. SEC. <br /> 164 165 Sand LOCATION SKETCH ACTIVITY �) <br /> NORTH ---/ NEW WELL <br /> 165 173 Clay <br /> 173 184 Sand MODIFICATION/REPAIR <br /> —Deepen <br /> 184 200 Shale —Other(Specify) <br /> 200 219 Sand <br /> 219 225 Clay — DESTROY <br /> and Materials <br /> 225 234 Sand Under"GEOLOGIC LOG' <br /> PLANNED USES(.) <br /> 234 243 Clay WATER SUPPLY <br /> ~ <br /> 243 265 Sand __ie Domestic— Public <br /> C/) <br /> 265 270 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 /> lllustmre 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 blC <br /> WATER LEVEL EL (Ft.)&DATE MEASURED 10/1/2018 <br /> ESTIMATED YIELD (GPM)& TEST TYPE <br /> TOTAL DEPTH OF BORING 270 (Feet) TEST LENGTH <br /> (Hrs.) TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL 265 (Feet) M not be representative of a well's lon -term vield. <br /> DEPTH CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE HORS TYPE ✓) FROM SURFACE TYPE _ <br /> DIA. y w a MATERIAL t INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> (Inches) Z p GRADE DIAMETER OR WALL IF ANY MENT TONT(_ FILL FILTER PACK <br /> Ft. to Ft. m v LL (Inches) THICKNESS (Inches) FL to Ft. ✓) ✓ (TYPEISIZE) <br /> 0 245 11 <br /> 245 265 265 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 /> — Soil/Water Chemical Analysis 119 Albers Rd' Modesto CA 95357 <br /> — Other ADDRESS CITY STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION,1F 1T EJCISTS. Signed 10/19/18 665622 <br /> WELL DRILLERIAUTHORIZED REPRESENTATIVE DATE SIGNED C-57 LICENSE NUMBER <br /> DWR 198 REV.11-97 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />