Laserfiche WebLink
'The free Adobe Reader may be used to view and complete this form. However,software must be purchased to complete.save,and reuse a saved form. <br /> File Original with DWR State of California DWR Use Only—Do Not Fill In <br /> Page 11 of a2 Well Completion Report �--T <br /> Refer to indereclion ParoPiret $tete Well Number/Site Number <br /> Owner's Well Number MW-6B No. e0162824 <br /> Date Work Began 09/24/2012 Date Work Ended 10/1/2012 Latitude on nude <br /> Local Permit Agency San Joaal_in Cguol Environmental Health DepartmentIAFN/TlisiOI . I I I I <br /> Permit Number NA Permit Date <br /> Geologic Log Well Owner <br /> Orientation @Vertical @Horizontal @Angle Specify Name <br /> Drilling Method Hollow Stem Auger Drilling Fluid Bentonite mud Mailing Address <br /> Depth from Surface Description <br /> Feet to Feet Describe material rain size color,etc Cit State_Zi <br /> 51 0 Overcirilled Well Location <br /> Address 6437 West Banner Street <br /> City Lodi County San Joaquin <br /> Latitude N Longitude __ <br /> Can Min. Sec. Deo Min, Sec. <br /> Datum Decimal Lat. Decimal Long. <br /> ADN Book Page Parcel <br /> Townshi —Range Section <br /> Location Sketch Activit <br /> Sketchmust bedrawn by hand atterform is onner, O New Well <br /> North 0 Modification/Repair <br /> 0 Deepen <br /> O Other <br /> Destroy <br /> Dxnma wocedume end metanala <br /> undo,'GEOLOGIC LOG <br /> Planned Uses <br /> 0 Water Supply <br /> ❑Domestic ❑Public <br /> w []irrigation [:]Industrial <br /> 0 Cathodic Protection <br /> 0 Dewatering <br /> 0 Heal Exchange <br /> 0 Injection <br /> 0 Monitoring <br /> O Remediation <br /> 0 Sparging <br /> South 0 Test Well <br /> A Ante or III elatanae of wall from ra.aa,Wllanpe.ien«:. 0 Vapor Extraction <br /> ..om andad..h.on.P0 Other <br /> Phase be accunh.nd cam INe. <br /> ifilater Level and Yield of Completed Well <br /> Depth to first water (Feet below surface) <br /> Depth to Static <br /> Nfater Level (Feet) Date Measured <br /> Total Depth of Boring 51 Feet Estimated Yield (GPM) Test Type <br /> Total Depth of Completed Well 51 Feet <br /> Test Length (Hours) Total Drawdown_(Feet) <br /> 'Pfay not be re resentative of a well's long term yield. <br /> Casings Annular Material <br /> Depth from Borehole Wall Outside Sc•een Slot Size Depth from <br /> Surface Diameter Type Material Thickness Diameter T,fpe if Any Surface Fill Description <br /> Feet to Feet Inches Inches inches Inches Feet to Feet <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 All Well Abandonment <br /> Person Firm or Corporation <br /> ❑ Geophysical Log(s) 9245 Beatty Drive Suite A may.-�Sa me LD CA 95826 <br /> ❑ Soil/Water Chemical Analyses A .�. I%" city state zip <br /> ❑ Other Site Map Signed / 10/23/2012 848359 <br /> Attach additional information it it exists. - Licesed Water well Cor tractor Date Signed C-57 License Number <br /> DWR 188 REV,12" IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />