Laserfiche WebLink
'The free Adobe Reader may be used to view and completeon 1. l I owever,software must be purchased to complete,save reuse a saved form. <br /> File Original with DWR State of California JW DWR Use Only–Do Not Fill In <br /> 1VAI Completion Report <br /> Page 1 of 1 � I I � I I � <br /> Refer to Instruction Pamphlet State Well Number/Site Number <br /> Owner's Well Number ISCO-1 NO. e0272214 <br /> Date Work Began 06/12/2015 Date Wo <E nc :d 6/12/2015 --Latitude_L N Longitude I W <br /> Local Permit Agency San Joaquin County Environm;:nigiI;lealth Department <br /> Permit Number 72294 Permit Date ;5P 2,'.5 APNrrRS/Other <br /> Geologic Log Well Owner <br /> Orientation OVertical O Horizontal 0,1,nc le Specify_— Name Donald Rogers <br /> Drilling Method Hollow Stem Auger Dri lint F nid Bentonite mud <br /> — <br /> Depth from Surface Descripi:ioi Mailing Address 11900 South Union Road <br /> Manteca ca 95336 <br /> Feet to Feet Describe material, ra.1 s ze I:ofor,etc Cit State_Zi <br /> 40 0 Drill Sample and install usiriL_'ollow Well Location <br /> Stem Auger Address 515 West Charter Way <br /> __.. City Stockton County San Joaquin <br /> _—.. Latitude N Longitude _W <br /> Dec Min. Sec. Deq. Min. Sec. <br /> Datum Dec.Lat. Dec.Long. <br /> APN Book 147 Page 074 Parcel 08 <br /> Township —Range Section <br /> Location Sketch Activity <br /> ——- Sketch must be drawn by hand after form isprinted.) O New Well <br /> North 0 Modification/Repair <br /> _ O Deepen <br /> O Other <br /> -- 0 Destroy <br /> ___ Describe procedures and materials <br /> - under'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 Heat Exchange <br /> (j) Injection <br /> 0 Monitoring <br /> -- 0 Remediation <br /> --- 0 Sparging <br /> South 0 Test Well <br /> --.. <br /> Illustrate or describe distance of well from Vapor Extraction <br /> om roads,buildings,fences, 0 Other <br /> rivers,etc.and ahcmap. additional paper it necessary.Use <br /> '——- PteaP'..­be accuraattte anad cpm Isle. <br /> -- Water Level and Yield of Completed Well <br /> -- Depth to first water (Feet below surface) <br /> ---. Depth to Static <br /> Water Level (Feet) Date Measured <br /> Total Depth of Boring 40 __ _ Feet Estimated Yield* (GPM) Test Type <br /> Test Length (Hours) Total Drawdown (Feet) <br /> Total Depth of Completed Well 40 __ _ Feet "Ma not be representative of a well's long term yield. <br /> Casir �— Annular Material <br /> ;�_.. <br /> Depth from Borehole Wall Outside Screen Slot Size Depth from <br /> Surface Diameter Type Material Thickness Diameter Type if Any Surface Fill Description <br /> Feet to Feet Inches —— Inches In;hes Inches Feet to Feet <br /> 40 130 $ 1 Screen PVC Sch.40 2 Milled Slots 40 28 1 Filter Pack #3 <br /> 30 0 8 Blank PVC Sch.40 _ 2 28 25 Bentonite pellets <br /> 25 0 Cement Portland 1/11 <br /> Attachments Certification Statement <br /> ❑ Geologic Log t ie I I ndersigned,certify that this report is complete and accurate to the best of my knowledge and belief <br /> El Well Construction Diagram Na mu All Well Abandonment Inc <br /> Person,Firm or Corporation <br /> El Geophysical Log(s) 23( ; Fitzgerald Rd Suite B 'RanchoZordoya CA 95742 <br /> 11 Soil/Water Chemical Analyses Addrass - �,,Y✓'-'''Cay state zip <br /> Sitlni:: �' - !'" 6/22/2015 848359 <br /> 0 Other site map <br /> Attach additional information if it exists. C-5—7 Licensed water` e I Cont or Date Signed C-57 License Number <br /> DWR 188 REV.112006 IF„D[i-'IONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />