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ARCHIVED REPORTS XR0003373
EnvironmentalHealth
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3500 - Local Oversight Program
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PR0544596
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ARCHIVED REPORTS XR0003373
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Entry Properties
Last modified
6/24/2019 2:19:30 PM
Creation date
6/24/2019 1:33:11 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0003373
RECORD_ID
PR0544596
PE
3528
FACILITY_ID
FA0002064
FACILITY_NAME
7-ELEVEN INC. STORE #14117
STREET_NUMBER
2725
STREET_NAME
COUNTRY CLUB
STREET_TYPE
BLVD
City
STOCKTON
Zip
95204
CURRENT_STATUS
02
SITE_LOCATION
2725 COUNTRY CLUB BLVD
P_LOCATION
01
P_DISTRICT
003
QC Status
Approved
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EHD - Public
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ORIGINAL STATE OF CALIFORNIA <br /> THE RESOURCES AGENCY DD ROC fill hy Fife with I]V't/R DEPARTMENT OF WATER RESOURCES NO. 137329 <br /> of Intent No. WA,'ry WELL DRILLERS REPO-r'T <br /> i'em,it NO. or Date---7Z8-1432 State Well No. <br /> Other Nell ..\n,� NCAE•Q_ <br /> (1) OWNED: ,"a111E Robert Rishwain {i2) WELL LOG <br /> Address---45 <br /> Hunter 8 ware Plaza Total depth ft. Depth of completed well ft. <br /> I.r Stockton from _ to ft. Formation (Describe by color, character, size or ma[eriall <br /> city on Calif Zil0 - 2 adobe <br /> ; <br /> (2) LOCATION Or VVELL (See instructions): p 2 - 20 brown clay <br /> Cr�uniy San JC)g-q Zia Owner's Nell lurnberZp`14 2 20 - 37 brown & blew Cl - W San(„l 5t��- <br /> +0 Wdl address if different front above 2350 More in Rd 37 - 45 blue clay <br /> Tnu'nsl:ip Ba;,ge 45 54 clay & sand <br /> Section �- <br /> Mslance from cities, mads, railroads, fences,etc. 54 _ <br /> 58 s�::nd\, <br /> ` 58 - 67 sand .lay <br /> 67 - 69\ edwo. • C 1-'-an- -c-fa y <br /> 9 73 1V w light sand <br /> (3) TYPE OF WORD: 73 75 s',��d <br /> New Well [x Deepening Q <br /> Recnnsiructim, ❑ 80 <br /> Reconditioning ❑ �., -120 <br /> CEJ a <br /> Horizontal Well ❑ ].24 sand, ,J <br /> Destruction ❑ (pescnd 12 - 13Q b1,�ei Clay tl1` <br /> destruction materials and <br /> procedures in Item 12),, _ . <br /> ♦ < <br /> (4) PROPOSED I7S15 ♦ 1 <br /> Domestic "♦`� <br /> Irrigation - ^ ❑ w ,y ��.,� <br /> Industrial <br /> Test Well <br /> Stocl.� _ \`{ <br /> \ <br /> Diw,icipil�� d� <br /> _ WELL LOCATION SKETCH `♦ `Other <br /> (5) EQVIPMENT; (6) GRAVCL"PACK; <br /> otary \ <br /> lieverse ❑ ` 1'0 ❑ Size .Z ' <br /> I-cable [] Bucket ❑ f <br /> Air Q D! nater of bore �J <br /> Other 5 Q 1 <br /> ❑ 'acke 3-from_ to.. 0 ` \\ <br /> 7) CASING INSTALLED:k'-'+_ (8) PERFORATIbNS•`; _ <br /> cel I ", ' '. � \ <br /> L.r las[ic ❑ Concrete`s Type of perforati?a or site of screen/�\l _ <br /> From To.--,Dia. Ga�e-or Front-` To <br /> ft. it.; ?ixr. Nall ft. .,� ft. <br /> 80`' °,oD 12 80 120 \1 _ <br /> 1} WELL SEAL: ; <br /> 4PPas surface sanitary seal provided? Yes � NO L) If yes, to depth_ 55 ft, _ <br /> Were strata scaled against pollution? Yes [] NO ❑ Interval-----ft. <br /> mthod of sealin <br /> Work started___ Ig Complet - 19 <br /> DeQ} WATER LEVELS: WELL DRILLER'S STATEMENT: <br /> Depth of first water, if knawr�- _ _ <br /> of <br /> l4 ft' This well was drilled tinder my jurisdiction and this renort is trice tothe best rep <br /> Standing Ievcl after well completion- ft knowledge and beIiel. <br /> 1) WELL TESTS: <br /> y s well test made? YesSICN$D <br /> Ivpe ❑ No ❑ if yes, by whom? <br /> of test (Well Driller) <br /> Pump ❑ Bailer Q Air lift 1] NAM Noack Pum <br /> Depth to mater at start of test ft. At end of test-ft . <br /> charge ga]/min after / <br /> r•(Person, firin, or corporation) (Typed or printed) <br /> hours 11'ater temperath[re Address P• ©- Box 908 <br /> i. analysis made? Yeses E] No ❑ If yes, by whom? <br /> Ieetric lag made? 95201 <br /> City Stockton, Calif <br /> :1 <br /> Zip <br /> Yes ❑ No a If yes, attach copy to this reportLicense No. 355213 <br /> Date of this report _ <br /> I IR 180 MeV. 7.76, 1F ADDITIONAL SPACE 1S NEEDED. USE NEXT CONSECUTIVELY NUMBERED FORM <br /> ire <br /> fir <br />
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