Laserfiche WebLink
QUADRUPLICATE STATE OF CALIFORNIA DWR USE ONLY — DO NOT FILL IN <br /> For Local Requirements WELL COMPLETION REPORT F11 [ [ Ili III i <br /> Page I of I Refer to Instruction Pamphlet STATE WELL NOJ STATION NO. <br /> Owner's Well No. 95336 NO.e0333982 ❑ <br /> Date Work Began 1/6/2017Ended1/9/2017 LATITUDE LONGITUDE <br /> Local Permit Agency Environmental HPatth <br /> Permit No. Permit Date <br /> 76507 12/28/2016 APN/TRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(✓) -,e—' VERTICAL HORIZONTAL —ANGLE —(SPECIFY) Name Eric Isbell <br /> DRILLING ROTARY <br /> DEPTH FROM METHOD FLUID Mud Mailing Address 16772 S Austin Rd <br /> SURFACEDESCRIPTION Manteca CA 95336 _ <br /> Ft. to FL Describe material, grain, size, color, etc. CITY STATE ZIP <br /> 0; 12 Sand Address 16772 S.AUStIn htd L LOCATIO <br /> 12; 20 Clay City Manteca CA 95336 <br /> 20 26 Sand County San Joaquin <br /> 26; 31 Clay APN Book Page Parcel— <br /> 31 i 41 Sand Township Range Section <br /> 41 :: 70 Clay Latitude I I I <br /> 70: 85 Sand DEG. MIN. SEC. DEG. MIN. SEC. <br /> 85i 105 Clay LOCATIONTI <br /> SKETCH ACVITY <br /> F (✓) <br /> _YK NEW WELL <br /> 105 117 Sand <br /> MODIFICATIONMEPAIR <br /> 117; 209 Clay Deepen <br /> 209: 217!Sand Other(Specify) <br /> 217: 225:Shale _ DESTROY(Describe <br /> Procedures and Materials <br /> Under"GEOLOGIC LOG' <br /> PLANNED USES() <br /> WATER SUPPLY <br /> N __VL Domestic Public <br /> Q — Irrigation _ Industrial <br /> ul MONITORING <br /> TEST WELL— <br /> ATHODIC PROTECTION— <br /> HEAT EXCHANGE— <br /> DIRECT PUSH <br /> INJECTION — <br /> VAPOR EXTRACTION — <br /> SPARGINGAN _ <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 STATIC <br /> WATER LEVEL 44 (Ft.)&DATE MEASURED 1/9/2017 <br /> ESTIMATED YIELD (GPM)& TEST TYPE_ <br /> TOTAL DEPTH OFBORING 225 (Feet) TEST LENGTH <br /> (Hrs.) TOTAL DRAWDOWN (Ft) <br /> TOTAL DEPTH OF COMPLETED WELL 220 (Feet) May not be representative of a well's lon -term yield. <br /> DEPTH CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE BORE- nTYPE —,/ FROM SURFACE TYPE <br /> HOLEDIA• MATERIAL/ INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> Ft. to Ft. (inches) GRADE (lncMhEes)R OR WALL IF ANY THICKNESS (Inches) Ft. to Ft MENT TONT FILL FILTER PACK <br /> W (1) C.- <br /> 0 <br /> (TYPE/SIZE) <br /> 0; 200 11 PLASTIC 6 200 0 100 <br /> 200; 220 M5 1 '� 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,OjftIjCj TON PECO P <br /> Soil/Water Chemical Analysis _1 __ ___ CA 95357 <br /> Other ADDRESS CITY STATE ZIP <br /> ATTACH ADDITIONAL INFORMAnoN,IF IT EXISTS Signed01/18/17 668622 <br /> WELL DRILLERIAUTHORIZED R SENTATIVE DATE SIGNED C57 LICENSE NUMBER <br /> DWR 189 REV.11-97 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />