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ORIGINAL ,,,,,c�iAf-- STATF ()F (At 1)oltNln NOT F I <br /> File with DWR064�'o ¢ WELL COMPLETION REPORT <br /> Page—of Refer/a Inrlrurrron Pampblet STATE WELL NO!STATION NO <br /> Owners Well No No 500619 <br /> Date 1t'orl. Began —5 —9 I ndt d LATITUDE LONGITUbE <br /> Local Permit Agency San Joaquin Health Dist. <br /> Permit No _ - 9970 Permit DataP ' <br /> ' GEOLOGIC LOG WELL 014rER <br /> ORIENTATION (� VERTICAL — HORIZONTAL _„_ ANGLE _ (SPECIFY) Name ... M.L. MOret Construction <br /> DEPTH FROM DEPTH TO FIRST WATER (Ft) BELOW SURFACE Mailing Address 25550 E. Magnolia Ave. <br /> SURFACE DESCRIPTION E.s_c_alon Ca 95320 <br /> Ft to Ft Descnbc material Rrarn sire color etc CITY STATE ZIP <br /> WELL LOCATION <br /> Address 1180 W. Main St. <br /> Abandoned old 6" steel casing--- city__R1 pon <br /> well - 661 dppp C,,nt, r" <br /> APN Boon Page arce <br /> and hackfill with dintTownship 0 Range Section <br /> ' r Of <br /> Latitude NORTH Longitude 1t WEST <br /> DEG Mthl SEC DEG MIN SEC <br /> LOCATION SKETCH — ACTIVITY (z�) <br /> NORTH — NEW WELL <br /> MODIFICATION I REPAIR <br /> —Deepen <br /> —Other(Specify) <br /> i <br /> ' X X DESTROY(Deacnbe <br /> i Procedures end Matenalli <br /> Under GEOLOGICLOG) <br /> U3 y PLANNED USE(S) <br /> LuM(J ) <br /> — ONITORING <br /> WATER SUPPLY <br /> Domestic <br /> , <br /> — Public <br /> ._.,� Irngalipn i <br /> i <br /> — Industrial <br /> i <br /> f — TEST WELL <br /> — CATHODIC PROTEC <br /> SOUTH TION <br /> Illustrate m Describe Distance of Well from Landmarks — OTHER(Specify) <br /> such as Roads Buildings Fences Rivers etc <br /> PLEASE BE ACCURATE G COMPLETE. <br /> DRILLING <br /> METHOD FLUID <br /> WATER LEVEL & YIELD OF COMPLETED WELL <br /> DEPTH OF STATIC <br /> WATER LEVEL (Ft) b DATE MEASURED <br /> ESTIMATED YIELD' (GPM) b TEST TYPE <br /> TOTAL DEPTH OF BORING (Feet) TEST LENGTH (Hra) TOTAL DRAWDOWN (Ft} <br /> TOTAL DEPTH OF COMPLETED WELL (Feet) *May not be representative of a well's long-term yield <br /> �DEPTHBORE CASING(S) DEPTHANNULAR MATERIAL <br /> FRHOLE TYPE : FROM SURFACE TYPE <br /> DIA z a MATERIAL/ INTERNAL GAUGE SLOT SIZE <br /> K o'- a GRADE DIAMETER OR WALL IF ANY CE BEN <br /> (Inches) FILTER PACK <br /> Ft t0 Fi m �� = (inches) THICKNESS (Inches) Ft to Ft MENT TON]TE FILL (TYPEISIZE) <br /> ATTACHMENTS CERTIFICATION STATEMENT <br /> ___. Geologic Log I the undersigned Certify that this report is complete and accurate to the hest of my knowledge and belief <br /> f — well Constructian Diagram NAME Hennings Bros. Drilling Co. ,Inc. <br /> Geophysical (PERSON FIRM OR CORPORATION) (TYPED OR PRINTED) <br /> — <br /> SoillWeler Chemical Analyea8 3525 Pelandale Ave. Modesto CA 95356 <br /> Other <br /> ADDRESS CITY STATE ZIP <br /> ..._. ::1L1�' t� <br /> ATTACH ADDITIONAL INFORMATION IF IT EXISTS Signed `-� 9 -10-96 290813 1 <br /> WELL ORtt ER AUTHORIZED REPRBINTATIVE 4 DATE SIGNED C-57 LICENSE NUMBER <br /> n tam RE% 7 90 IF ADDITIONAL SPACE IS NEEDEb USE NEX CONSECUTIV L NUMBERED FORM <br />