Laserfiche WebLink
QUADRUPLICATE STATE OF CALIFORNIA DWR USE ONLY — DO NOT FILL IN <br /> For Local Requirements WELL COMPLETION REPORT <br /> Page 2 of 2 Refer to Instruction Pamphlet STATE WELLNO./STATION NO. <br /> Owner's Well No. 95366 NO.e0372176 <br /> Date Work Began 2/28/2019 Ended3/1/2019 LATITUDE LONGITUDE <br /> Local Permit Agency Environmental Health I I I I I I I I I I I I I <br /> Permit No. wp0039184 Permit Date 1/11/2019 APN/TRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(✓) --,/—VERTICAL HORIZONTAL — ANGLE —(SPECIFY) Name DePalma Farms <br /> DRILLING ROTARY <br /> DEPTH FROM METHOD FLUID Mud Mailing Address 18666 E. HM 120 _ <br /> SURFACEDESCRIPTION Ripon CA 95366 <br /> Ft. to Ft. Describe material, grain, size, color, etc. CITY STATE ZIP <br /> 356 375 Shale Address 19002 S CarroltonFld LOCATIO <br /> City Ripon CA 95366 <br /> CountySan Joaquin <br /> APN Book Page Parcel <br /> Township Range Section <br /> Latitude I I <br /> DEG. MIN. SEC. DEG. MIN. SEC. <br /> LOCATION SKETCH ACTIVITY ) <br /> NORTH __VL NEW WELL <br /> MODIFICATION/REPAIR <br /> —Deepen <br /> —Other(Specify) <br /> — DESTROY (Describe <br /> Procedures and Materials <br /> Under"GEOLOGIC LOG' <br /> PLANNED USES(z) <br /> WATER SUPPLY <br /> r~i) Domestic— Public <br /> Irrigation — Industrial <br /> ul MONITORING— <br /> TEST WELL— <br /> ATHODIC PROTECTION— <br /> HEAT EXCHANGE— <br /> DIRECT PUSH— <br /> INJECTION— <br /> VAPOR EXTRACTION— <br /> SPARGING— <br /> SOUTH REMEDIATION— <br /> IIlustrate or Describe Distance of Well from Roads, Buildings, <br /> Fences,Rivers,etc. and attach a map. Use additional paper if OTHER(SPECIFY)— <br /> necessary.PLEASE BE ACCURATE & COMPLETE. <br /> WATER LEVEL&YIELD OF COMPLETED WELL <br /> DEPTH TO FIRST WATER (Ft.)BELOW SURFACE <br /> DEPTH OF STAT <br /> WATER LEVEL (Ft.)&DATE MEASURED 3/1/2019 <br /> ESTIMATED YIELD ' (GPM)& TEST TYPE <br /> TOTAL DEPTH OF BORING 375 (Feet) TEST LENGTH (Hrs.) TOTAL DRAWDOWN (Ft) <br /> TOTAL DEPTH OF COMPLETED WELL 360 (Feet) IMay not be representative o a well's lon -term yield <br /> DEPTHCASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE HOLE MTjE _!L FROM SURFACE TYPE <br /> DIA• MATERIAL/ INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> Ft o Ft (Inches) GRADE DIAMETER OR WALL IF ANY MENT TONI FILL FILTER PACK <br /> (Inches) THICKNESS (Inches) Ft. to Ft. ✓ (TYPE/SIZE) <br /> (_) U <br /> 0 240 21 PLASTIC 12 900 0 5k / <br /> 240 360 50 360 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 MASELLIS DRILLING INC _ <br /> — Geophysical Log(s) (PERSON,FIRM,OR CORPORATION) (TYPED OR PRINTED) <br /> — Soil/Water Chemical Analysis 119 Albers Rd Modesto CA 95357 <br /> — Other ADDRESS CITY STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION,IF IT EXISTS. Signed 03/19/19 668622 <br /> WELL DRILLER/AUTHORIZED REPRESENTATIVE DATE SIGNED C-57 LICENSE NUMBER <br /> DWR 188 REV.11-97 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />