Laserfiche WebLink
QUADRUPLICATE STATE OF CALIFORNIA DWR USE ONLY — DO NOT FILL IN <br /> For Local Requirements WELL COMPLETION REPORT <br /> Page 2 of 2 Refer to Instruction Pamphlet STATE WELL NO./STATION NO. <br /> Owner's Well No. 92612 No.e0372165 ❑I I I 1 171❑ <br /> Date Work Began 11/8/2018 Ended11/17/2018 LATITUDE LONGITUDE <br /> Local Permit Agency Environmental Health 1 11 1 I 1 1 1 1 I <br /> Permit No. wp0038759 Permit Date 9/10/2018 APN/rRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(✓) v-VERTICAL —HORIZONTAL ANGLE —(SPECIFY) Name Gilmore Rd LLC <br /> DRILLING ROTARY <br /> DEPTH FROM METHOD FLUID Mud Mailing Address 18301 Von Karman Ste.250 <br /> SURFACEDESCRIPTION Irvine CA 92612 <br /> Ft. to Ft. Describe material, grain, size, color, etc. CITY STATE ZIP <br /> 370 3941 Black SandL LOCATIO <br /> Address 7010 N. GilmoreVffN <br /> 394 4181 Shale City Linden CA 95236 <br /> 418 4441 Black Sand County San Joaquin <br /> 444 4501 Shale APN Book Page Parcel <br /> 450 4721 Black Sand Township Range Section <br /> 472 481 Shale Latitude I I <br /> 481 505 Black Sand DEG. MIN. SEC. DEG. MIN. SEC. <br /> 505 509 Shale LOCATION SKETCH ACTIVITY (✓) <br /> NORTH � NEW WELL <br /> 509 543 Black Sand <br /> 543 558 Shale MODIFICATION/REPAIR <br /> —Deepen <br /> 558 574 White Sand —Other(Specify) <br /> 574 587 Shale <br /> 587 595 Sand — DESTROY res(Describe <br /> Materials <br /> 595 600 Shale Under"GEOLOGIC LOG' <br /> PLANNED USESO <br /> WATER SUPPLY <br /> U) Domestic Public <br /> Q <br /> Irrigation — Industrial <br /> LLI 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, Buddmgs, <br /> Fences,Rivers,etc. and attach a map. Useadditional 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'1 5 (Ft.)&DATE MEASURED 11/17/2018 <br /> ESTIMATED YIELD ' (GPM)& TEST TYPE <br /> TOTAL DEPTH OF BORING 600 (Feet) TEST LENGTH <br /> (His.) TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL 600 (Feet) 1 May not be representative o a well's lon -term yield. <br /> DEPTHCASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE HOLE TYPE ✓) FROM SURFACE TYPE <br /> DIA• x w o MATERIAL/ INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> (Inches) Z w Zir p a GRADE DIAMETER OR WALL IF ANY MENT TONIT FILL FILTER PACK <br /> Ft. to Ft. m v � (Inches) THICKNESS (Inches) Ft. to Ft. ✓ (✓) �) (TYPE/SIZE) <br /> 0 420 24 ✓ <br /> 420 600 GRAVEL <br /> ATTACHMENTS (y> 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 MASFIS DRILLING INC <br /> — Geophysical Log(s) (PERSOfJ,'-`FIRM';OR CORPORATION) (TYPED OR PRINTED) <br /> — Soil/Water Chemical Analysis 119 Albers RdModesto CA 95357 <br /> — Other ADDRESS CITY STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION,IF IT DCISTS. Signed 01/11/19 668622 <br /> WELL DRILLER/AUTHORIZED REPRESENTATIVE DATE SIGNED C57 LICENSE NUMBER <br /> DWR 188 REV.11-97 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />