Laserfiche WebLink
'The free Adobe Reader may be used to view and compllo form, However,software must be purchased to complete,s0nd reuse a saved form. <br /> File Original with DWR State of California DWR Use Only—Do Not Fill In <br /> Well Completion Report �� T <br /> Page 1 of 1 Refer to Instruction Pamphlet I I <br /> State Well Number/Site Number <br /> Owner's Well Number SP-6A No. e0178555 <br /> Date Work Began 05/16/2013 Date Work Ended 5/16/2013 -�-��� <br /> g _ Latitude Longitude <br /> Local Permit Agency San Joaauin County Environmental Health Department <br /> Permit Number 67140 Permit Date 5/10/13 APN/TRS/Other <br /> Geologic Log Well Owner <br /> Orientation OVertical 0Horizontal OAngle Specify Name Donald Rogers <br /> Drilling Method Hollow Stem Auger Drilling Fluid none Mailing Address 11900 South Union Road <br /> Depth from Surface Description <br /> Feet to Feet Describe material,grain size,color,etc City Manteca State_CA__Zip 95336 <br /> Well Location <br /> 0 45 The boring was drilled with 8-inch hollow stem Address 515 West Charter Way <br /> auger and sample at 5-foot intervals. Cit Stockton <br /> Y County San Joaquin <br /> Latitude N Longitude _y�r <br /> The well materials described below were installed -De q. Min. Sec. Dep. Min. Sec. <br /> into the boring. Datum Decimal Lat. Decimal Long. <br /> AF'N Book 147 Page 074 Parcel 08 <br /> The flush mount well box was installed with a Townshi Ranga Section <br /> concrete apron. Location Sketch Activit <br /> Sketch must be drawn by hand after form is printed. Oi New Well <br /> North 0 Modification/Repair <br /> 0 Deepen <br /> 0 Other <br /> 0 Destroy <br /> Describe procedures and materials <br /> under'GEOLOGIC LOG' <br /> f Planned Uses <br /> t' 0 Water Supply <br /> [:]Domestic [IPublic <br /> rr l„ nl See Attached CU []Irrigation ❑Industrial <br /> w <br /> 0 Cathodic Protection <br /> 0 Dewatering <br /> 0 Heat Exchange <br /> 0 Injection <br /> 0 Monitoring <br /> 0 Remediation <br /> 0 Sparging <br /> South 0 Test Well <br /> Illustrate or describe distance of mIl from roads,buildings,fences, 0 Vapor Extraction <br /> river;,etc.and attach a map. Use additional paper it necessary. O Other <br /> Please be accurate and com tete. <br /> alter Level and Yield of Completed Well <br /> Depth to first water (Feet below surface) <br /> Depth to Static <br /> Witter Level (Feet) Date Measured <br /> Total Depth of Boring 45 Feet Estimated Yield' (GPM) Test Type <br /> Total Depth of Completed Well 45 Feet Test Length (Hours) Total Drawdown (Feet) <br /> L:May not be representative of a well's long term yield. <br /> Casings Annular Material <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 Inches Inches Feet to Feet <br /> 45 43 18 Screen PVC Sch.40 .218 2 Milled:;lots 0.020 45 41 1 Filter Pack #3 Sand <br /> 43 0 18 Blank PVC Sch.40 .218 2 41 39 Bentonite Chips <br /> 39 1 Cement Portland 1/II <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, Inc. <br /> Person,Firm or Corporation <br /> IJGeophysical Logs) 9245 Beatty Drive Suite A Sacramento CA 95826 <br /> ❑ Soil/Water Chemical Analyses Address city state zip <br /> ❑ Other Site Mal Signed -- 6/6/2013 848359 <br /> Attach additional information if it exists. icdnsed Water Well Contractor Date Signed C-57 License Number <br /> DWR 188 REV.1/2006 IF ADDITIONAL SPACE IS NEEDED,USE NE KT CONSECUTIVELY NUMBERED FORM <br />