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 1 of 1 Well Completion Report <br /> Refer to Instruction Pamphlet State Well Number/Site Number <br /> Owner's Well Number WP0038811 No. xxxxxxxN W <br /> Date Work Began 10/01/2018 Date Work Ended 10/9/2018 I�tud I Longitude <br /> Local Permit Agency San Joaquin <br /> Permit Number WP0038811 Permit Date 9/26/18 APN/TRS/other <br /> Geologic Log Well Owner <br /> Orientation OVertical 0Horizontal OAngle Specify Name Dwight Mitchell <br /> Drilling Method Direct Rotary Drilling Fluid Bentonite mud Mailing Address 2812 Pacific Ave <br /> Depth from Surface Description <br /> Feet to Feet Describe material,grain size,color,etc City Stockton State Ca Zi <br /> 0 5 Top Soil Well Location <br /> 5 27 Clay Address 1200 N Fine Rd <br /> 27 50 Gravel City Linden County San Joaquin <br /> 50 63 Sand Latitude N Longitude �N <br /> 63 83 Sand Gravel Dee. Min. Sec. Deo. Min. Sec. <br /> 83 95 Sand Datum Dec.Lat. Dec.Long. <br /> 95 126 Clay APN Book Page Parcel <br /> 126 134 sand Townshi Ran a Section <br /> 134 164 Clay Location Sketch Activity <br /> 164 195 Sand Sketch must be drawn b hand after form is printed.) O New Well <br /> North O Modification/Repair <br /> 195 216 Shale O Deepen <br /> 216 238 Sand O Other <br /> 238 250 Clay O Desbe <br /> criprocedures and materials <br /> 250 268 Gravelunder'GEOLOGIC LOG" <br /> u <br /> 268 300 Black sand rg ," Planned Uses <br /> O Water Supply <br /> ❑Domestic [:]Public <br /> `�� Z • 11 3 <br /> U-1 ❑Irrigation ❑Industrial <br /> ��I1R0�lN��NTALHFI;LT�� 0DewateringCathodic <br /> rotection <br /> O Heat Exchange <br /> O Injection <br /> O Monitoring <br /> O Remediation <br /> O Sparging <br /> South O Test Well <br /> Illustrate or describe distance of well from mads,buildings,fences, O Vapor Extraction <br /> rivers,etc.and attach a map.Use additional paper ff necessary. O Other <br /> Please be accurate and com tete. <br /> Water1 11 <br /> 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 300 Feet Estimated Yield* 20 (GPM) Test Type <br /> Total Depth of Completed Well 300 Feet Test Length (Hours)Total Drawdown (Feet) <br /> May not be representative of a well's long term yield. <br /> Casings Annular Material <br /> Depth from Borehole Type Material Wall Outside Screen Slot Size Depth from <br /> Surface Diameter Yp Thickness Diameter Type if Any Surface Fill Description <br /> Feet to Feet Inches Inches Inches Inches Feet to Feet <br /> 1 1280 12 Blank PVC Sch.80 6 1 118 Bentonite <br /> 280 300 12 Screen PVC Sch.80 6 118 300 Filter Pack Grit Sand 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 Castle Well Drilling <br /> ❑ Lo Person,Finn or Corporation <br /> Geophysical <br /> g(S) P.O Box 1446 Riverbank CA 95367 <br /> ❑ Soil/Water Chemical Analyses Address / city State zip <br /> ❑ Other Signed /�. r�j� /j/ ,rl 10/09/2018 1044863 <br /> Attach additional information if it exists. C-57 Li6ensed Water Well Contractor Date Signed C-57 License Number <br /> DWR 188 REV.1/2006 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />