Laserfiche WebLink
QUADRUPLICATE STATE OF CALIFORNIA �D R USE ONLY — DO NOT FILL IN <br /> For Local Requirements WELL COMPLETION REPORT I I I I I I I I I I <br /> Page 1 of 1 Refer to Instruction Pamphtel STATE WELL NO./STATION NO. <br /> Owner's Well No. 95215 No.e0352911 i 1 101 ❑ <br /> Date Work Began 9/7/2017 Ended9/8 2017 LATITUDE LONGITUDE <br /> Local Permit Agency Environmental Health LL__L—L <br /> Permit No. WP0037074 Permit Date 8/14/2017 APN/TRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(✓) VERTICAL —HORIZONTAL —ANGLE (SPECIFY) Name Cheryl&Joseph Lombardi <br /> DRILLING ROTARY <br /> DEPTH FROM METHOD FLUID Mud Mailing Address 16998 E. Gawne Rd <br /> DESCRIPTION Stockton CA 95215 <br /> Ft. to Ft Describe material grain, size, color, etc. CITY STATE ZIP <br /> 0 3 Top Soil WE LOCATIO <br /> Address 17071 E.Mariposa <br /> 3 23 Clay City Stockton CA 95215 <br /> 23 40 Sand Sand <br /> County cSa�l OQ Q UI✓I <br /> 40 47 APN Book Page Parcel <br /> 42 47 Sand Township Range Section <br /> 47 78 Clay Latitude . I I <br /> 78 80 Sand DEG. MIN. SEC. DEG. MIN. SEC. <br /> 80 190 Clay LOCATION SKETCH ACTIVITY (✓) <br /> NORTH __1k/ NEW WELL <br /> 190 203 Sand <br /> MODIFICATION/REPAIR <br /> 203 210 Clay —Deepen <br /> 210 212 Gravel —Other(Specify) <br /> 212 236 Clay <br /> 236 253 Gravel and Sand —Pied res OY (Describe <br /> Materials <br /> Under"GEOLOGIC LOG' <br /> 253 283 Clay PLANNED USES(.4) <br /> 283 286 Sand WATER SUPPLY <br /> 286 360 Clay W y Domestic— Public <br /> 360 368 Sand — Irrigation — Industrial <br /> 368 375 Clay 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. <br /> SPECIFY)_necessary. PLEASE BE ACCURATE & COMPLETE. <br /> WATER LEVEL&YIELD OF COMPLETED WELL <br /> DEPTH TO FIRST WATER (Ft.)BELOW SURFACE <br /> DEPTH OF STATIC <br /> WATER LEVEL 122 (Ft.)&DATE MEASURED 9/8/2017 <br /> TOTAL DEPTH OF BORING375 ESTIMATED YIELD (GPM)& TEST TYPE <br /> ' <br /> (Feet) TEST LENGTH (Hrs.) TOTAL DRAWDOWN (Ft) <br /> TOTAL DEPTH OF COMPLETED WELL 375 (Feet) M not be representative o a well's long-term yield <br /> DEPTH BORE- CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE HOLE TYPE_ > FROM SURFACE PE <br /> DIA. Y w a MATERIAL/ INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> (Inches) Z p a GRADE DIAMETER OR WALL IF ANY MENT TONIT FILL FILTER PACK <br /> Ft. to FL m v (Inches) THICKNESS (Inches) Ft. to Ft. ✓ (� �) (TYPE/SIZE) <br /> 0 355 105/8 <br /> 355 375 .045 100 375 &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 Diagrar[� NAME MASELL RILLING LK _ <br /> Geophysical Log(s) (PERSON,FI ?� 7 D) <br /> — Soil/Water Chemical Analysis. 1 I R ] <br /> Otter ADDRESSCITY STATE ZIP <br /> ATTACH ADDITIONAL INFORV*Cj1,?z12@1krS. fined 09/20/17 668622 <br /> WELL DRILLER/AUTHORIZED REPRESENTATIVE r DATE SIGNED C-57 LICENSE NUMBER <br /> DWR Iss REV.11-97 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br /> L-NVIRONMENTAL HEALTH <br /> PERMIT(SERVILES <br />