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UPi14.:tII4AL SIAIL OF (ALIFURNIA D WR — N F It. <br /> Fere with DWR WELL COMPLETION REPORT 6 <br /> I <br /> 1 I <br /> Page 1 1 o{ Refer to Instructron Pamphlet STA WELL NO/STATi NO <br /> Owner s Well No No 433846 ❑ <br /> Date Wort. Began Ended 9-14-21 � LATITUDE LONGITUDE <br /> � <br /> Local Permit Agency _ JQaq]an CO_ 131-y- of Env_ Health <br /> Permit Na 1-1332 Permit Date 6-6-91 APNITRSIOTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION (!} VERTICAL — HORIZONTAL _ ANGLE _ (SPECIFY) ~Tame Alegre TI llcka-ng <br /> DEPTH TO FIRST WATER (Ft) BELOW SURFACE Mailing Address 802 N. Cliff Ave. <br /> DEPTH FROM ,? <br /> SURFACE DESCRIPTION _ LOCI , Ca. 95240 <br />' Ft to Ft Desmbe matenal grarn nze color cu CITY WLOCATION- ^. STATE — ZIP <br /> ELL LOCATION <br /> Address_ Anderson St. <br /> CItV Stockton Ca. <br /> 21 30 Blue clay County_ San Joaquin _ <br />' 30 38 Fine blue sand APN Boot, Page Parcel#163-260-12 - <br /> 38 ' 67 Blue ClaTownship �Range��Section _ l <br /> 67 75 Blue sand Latitude NORTH Longitude _ west <br />' 75 79 Blue Gla DEG MIN SEC DEG MIN SEC <br /> LOCATION SKETCH ACTIVITY (,z::) <br /> 79 84 Blue sandy <br /> ORTH 13 NEW WELL <br /> 34 ' 120 Slue clay MODIFICATION/REPAIR <br /> 120 125 Blue sand � Deepen <br /> _ <br /> 125 128 Blue clay ~ Other(Speeity) <br /> 128 0 ' Blue sand <br /> 133 Blue clay <br /> DESTROY(Describe <br /> 13 Blue sand Procedures and Marenats <br /> ' Under GEOLOGICLOG) <br /> 138 42 Blue clayPLANNED USES) <br /> A (� N J <br /> 142 ' 145 Blue Sand MONITORING <br />' 145 ; 155 Blue clay <br /> WATER SUPPLY <br /> 155 ' 1 Blue sand <br /> X Domestic <br /> 165 1 Blue clay <br /> Blue sand ,� Public <br /> r { <br /> l 1 ( — Irngatmn <br /> L� Induatrial <br /> l _ TEST WELL <br /> _. CATHODIC PROTEC <br /> SOUTH TION <br /> Illustrate or Describe Distance of Well from Landmarks OTHER(Specify) <br /> such as Roads Butldings Fences Rivers etc <br /> PLEASE BE ACCURATE G COMPLETE <br /> DRILLING <br /> METHOD T'C'1'ra YT FLUID hj3ter <br /> WATER LEVEL & YIELD OF COMPLETED WELL <br /> DEPTH <br /> WATER OLEVEI TIC 42 (Ft) $ DATE MEASURED 8-15-91 <br /> ESTIMATED YIELD (GPM) d TEST TYPE <br />' TOTAL DEPTH OF BORING 195 (Feet) TEST LENGTH (Hra) TOTAL DRAWDOWN (Ft) <br /> TOTAL DEPTH OF COMPLETED WELL S (Feet) 'May not be representative of a well's long-terns yield <br />' DEPTH CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE BORE TY�V_1' FROM SURFACE TYPE <br /> DIA MATERIAL! INTERNAL GAUGE SLOT SIZE CEpnchea) DIAMETER OR WALL IF ANYFt fo Ft GRADE MENT TONITE FILLFILTER PACK <br /> (inches) THICKNESS (inches) F( to FI (� } (� ) (� } (TYPEISIZE) <br />' 0 175 <br /> " " 160 0 100 X <br /> =1� 199 " " 062 100 195 6-12 sand <br /> ATTACHMENTS (!) CERTIFICATION STATEMENT <br /> ! the undersigned certify that this report Is complete and accurate to the gest of my knowledge and babes <br /> Geoiopic Lap 7 7 � <br /> :, <br /> Well Construction Diagram NAME Calwater DrjLllin 0 q '^ 1n4. <br /> (PEFWN FIRM, OR CORPD9/ITIDN) (TYPED DR PRfmE ) <br /> Geophysical Log(s) 300 S. Kilroy _ Turlock, Ca. 95380 <br /> �— Soil/Water Chemical Anetyses ADORE - ZIP <br /> Other ✓� ' CITY STATE <br /> stoned r. �-1 91 3212..52 <br /> ATTACH ADDfTTONAL INFORMATION IF IT EXISTS WELL DRI AUT NTJYT1yE D SIGNS C 57 LICENSE NUMBER <br /> DWR 188 REV T 90 IF ADDITIONAL SPACE IS NEEDED, USE NEXT CONSECUTIVELY NUMBERED FOR <br />