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 <br /> DWR Use Only–Do Not Fill In <br /> Page 1 of 1 Well Completion Report I <br /> Refer to Instruction Pamphlet L_1 I I I I I I I I I <br /> Owner's Well Number MW 1 No. e0301551 ___ _State Well Number/Site Number <br /> Date Work Began 01/13/2016 Date Work Ended 1/20/2016 _ ( 1 1 1 N I Ft -I �. I 'y'/ <br /> ..- <br /> Local Permit Agency San Joaauin County Environmental H alth D i)artm nt Latitude Longitude _ <br /> Permit Number SR0073506 Permit Date 10/27/15 C—�� <br /> APN/TRS/Other I I I <br /> Geologic Log Well Owner <br /> Orientation OVertical 0Horizontal OAngle Specify. <br /> tJame Swaran Chouhan <br /> Drilling Method Hollow Stem Auger <br /> Drilling Fluid Bentonite mud <br /> Depth from Surface Description Mailing Address 1632 Paola Place <br /> Feet to Feet Describe material,grain size,color,etc (,ity Manteca State CA_Zip 95337 <br /> 56 0 Drilled Out to total depth utilizing a truck mounted Well Location <br /> CME-75 with 8-inch hollow stem augers Address 701 East Charter Avenue <br /> City Stockton County San Joaquin <br /> Latitude N Longitude <br /> Deq Min Sec Dad Min Se <br /> Datum Dec. Lat. Dec. Long. <br /> 1)-MFER 7 4 201b APN Book 147 Page 343 Parcel 11 <br /> Township Ran e Section <br /> Location Sketch Activity <br /> (Sketch mus;oe drawn s !lard after form is nnied) New Well <br /> ENVIRONMENTAL HEALTH No-!!' O Modification/Repair <br /> RIMIUSERVICES O Deepen <br /> O Other <br /> Destroy <br /> Describe procedures and materials <br /> under'GEOLOGIC LOG' <br /> Planned Uses <br /> O Water Supply <br /> [:]Domestic ❑Public <br /> m ❑Irrigation <br /> w <br /> El Industrial <br /> O Cathodic Protection <br /> O Dewatering <br /> O Heat Exchange <br /> O Injection <br /> O Monitoring <br /> O Remediation <br /> O Sparging <br /> South O Test Well <br /> musuaie o �escrce:esla�cr of wea rw.m nods buidngs fences O Vapor Extraction <br /> CI:anC andCn a may USe add,liU gal PaVCI it necessary O Other <br /> Please be accurate and complete <br /> Water Level and Yield of Completed Well <br /> DE!pth to first water (Feet below surface) <br /> Depth to Static <br /> Water Level (Feet) Date Measured <br /> Total Depth of Boring 56 Feet Estimated Yield' (GPM) Test Type <br /> Total Depth of Completed Well 56 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 /> l <br /> Depth from Borehole Type MateriaWall Outside Scn)en Slot Size Depth from <br /> Surface Diameter Thickness Diameter Type 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) 3369 Fitzaerald Road mho Corova CA 95742 <br /> ❑ Soil/Water Chemical Analyses Address:. �- <br /> ` /��' CiIY State Zip <br /> 0 Other Site Map Signed 2/22/2016 848359 <br /> Attach additional Information if it exists. C-57 L,cense W eIl Contractor Date Signed C-57 License Number <br /> DWR 188 REV 1/2006 IF bDDITIONAI,,SPACE IS NEEDED USE NE)J CONSECUTiVEL f NUMBERED FORM <br />