Laserfiche WebLink
QUADRUPLICATE STATE OF CALIFORNIA DWR USE ONLY — DO NOT FILL IN <br /> For Local Requirements WELL COMPLETION REPORT <br /> Page 1 of 1 Refer to Instruction Pamphlet STATE WELL NO./STATION NO. <br /> Owner's Well No. 95336 No.e0341699 <br /> Date Work Began 4/24/2017 Ended4/28/2017 LATITUDE LONGITUDE <br /> Local Permit Agency Environmental Health <br /> Permit No. 76748 Pem it Date 2/8/2017 APWMS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(✓) --,e–VERTICAL —HORIZONTAL —ANGLE —(SPECIFY) Name Raymond Quaresma <br /> DRILLING ROTARY <br /> DEPTH FDESCRIPTION FROM METHOD FLUID Mud Mailing Address 26301 S. Union Rd. <br /> Manteca CA 95336 <br /> Ft. to Ft. Describe Material grain, size, color, etc. CITY y� STATE ZIP <br /> 0 3 Top Soil Address 26767 S Union KIS LL LOCATIO <br /> 3 14 Sand City Manteca CA 95336 <br /> 14 20 Clay County San Joaquin <br /> 20 47 Sand APN Book Page Parcel <br /> 47 60 Blue Clay Township Range Section <br /> 60 74 Brown Clay Latitude t 1 1 <br /> 74 77 Sand DEG. MIN. SEC. DEG. MIN. SEC. <br /> 77 81 Clay LOCATION SKETCH ACTIVITY (✓) <br /> 81 95 Sand NORTH --I/– NEW WELL <br /> 95 103 ClayMODIFICATIONIREPAIR <br /> —Deepen <br /> 103 109 Sand —Other(Specify) <br /> 109 125 Clay <br /> 125 134 Sand — DESTROY <br /> (Describe erials <br /> Under"GEOLOGIC LOG' <br /> 134 155 Blue Clay PLANNED USES() <br /> 155 194 Sand WATER SUPPLY <br /> 194 205 Clay ~i� Domestic— Public <br /> Irrigation — Industrial <br /> ul MONITORING— <br /> TEST WELLRECEIVED —. <br /> ATHODIC PROTECTION— <br /> HEAT EXCHANGE— <br /> DIRECT PUSH_ <br /> JAN 18 2019 INJECTION— <br /> VAPOR EXTRACTION— <br /> SPARGING— <br /> I � t SOUTH REMEDIATION— <br /> lllusirale or Describe Distance of Well from Roads, Buildings, <br /> D E PA I I I I L N T 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 10 (Ft.)&DATE MEASURED 4/28/2017 <br /> ESTIMATED YIELD (GPM)& TEST TYPE <br /> TOTAL DEPTH OF BORING 205 (Feet) TEST LENGTH (Hrs.) TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL 200 (Feet) May not be representative o a well's loo -term yield. <br /> DEPTH CASING(S) DEPTH ANNULAR MATERIAL. <br /> FROM SURFACE HOLE E TYPE ✓ FROM SURFACE TYPE <br /> DIA. 1 w g MATERIAL/ INTERNAL GAUGE SLOT SIZE CE- <br /> DIAMETER Z p u GRADE DIAMETER OR WALL IF ANY MEN+ TONT FILL FILTER PACK <br /> Ft. to Ft. m c� LL (Inches) THICKNESS (Inches) Ft. to Ft. ✓ (✓) V) (TYPE/SIZE) <br /> 0 120 24 .� <br /> 120 200 0 50 200 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) (PERSO M OR CORP TION AINTED), <br /> — Soil/Water Chemical Analysis 119 AI 7 <br /> — Other ADDRESS CITY STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION,IF IT EXISTS. Signed 06/07/17 668622 <br /> WELL DRILLER/AUTH D REPRVtENTATIVE DATE SIGNED C-57 LICENSE NUMBER <br /> DWR 188 REV.11-97 IF ADDITIONAL SPACE IS NEEDED.USE NEXT CONSECUTIVELY NUMBERED FORM <br />