Laserfiche WebLink
.The free Adobe Reader may be used to view and complete th -lowever,software must be purchased to complete,save,louse a saved form. <br /> File Original with DWR 0 State of California _-DWR Use Only-Do Not Fill In <br /> VII0II Completion Report <br /> Page 1 of 1 Refer to InstruGlon Pamphlet State Well Number/Site Number <br /> Owner's Well Number MW-12 No. e02134628 N <br /> Date Work Began 04/09/2015 Date W:rk El,:ad 4/9/2015— Latitude Longitude <br /> Local Permit Agency San Joaauin County Environr:LPdij1;jI,Health Deoaltment APNlrRS/Olher <br /> Permit Number Permit Date 4 31:,5 _ <br /> Geologic Log Well Owner <br /> Orientation Overtical O Horizontal OArgl i Specify__ Name Herman&Helen's Marina (DFRD 2029) <br /> Drilling Method Hallow Stem Auger Uilli ig F uid Bentonite mud Mailing Address 15135 West Eight MileRD <br /> Depth from Surface Descriliti an Stockton State CA 95215 <br /> Feet to Feet Describe material t!dn 3!z,',color,etc Cil <br /> 13 0 2"Overdrill —_-. Well Location <br /> Address 15135 Eight Mile RD <br /> .---. City Stockton County San Joaquin <br /> Latitude N Longitude ___�N <br /> Deo. Min. Sec. Dec. Min. Sec. <br /> -- Datum Dec.Lat. Dec.Long. <br /> --" APN Book Page Parcel <br /> -- ' <br /> Township —Range Section <br /> -- Location Sketch Activi <br /> --- Sketch must be dran,n by hand atter form is noted. ONew Well <br /> North O Modification/Repair <br /> O Deepen <br /> O Othef <br /> -- ' O Destroy <br /> oesane woredmea and malMels <br /> "d",'GEOLOGIC LOG' <br /> -- ' Planned Uses <br /> -- O Water Supply <br /> --.. ❑Domestic El Public <br /> -- 3 w ❑Irrigation []Industrial <br /> .--.. O Cathodic Protection <br /> O Dewatering <br /> O Heat Exchange <br /> — O Injection <br /> ---' O Monitoring <br /> --- O Remediation <br /> .--.. O Sparging <br /> '— South O Test Well <br /> O Vapor Extraction <br /> rive— Illuers etc <br /> and <br /> ab�Galeas U.a.lham mads,Ouilf n., to^ccs, OOther <br /> s,et[.end riat amap.Use eEditimel paper it ne[eUery. <br /> '--- pknaMwand end com Mle. <br /> -- Water Level and Yield of Com plot Well <br /> --- Depth to first water (Feet below surface) <br /> .--.. Depth to Static (Feet) Date Measured <br /> Water Level <br /> Total Depth of Boring 13 —„_ Feet Estimated Yield' (GPM) Test Type <br /> — Test Length (Hours) Total Drawdown_(Feet) <br /> Total Depth of Completed Well 13 Feet eMa not be re resentative of a well's Ion term Yield. <br /> CasillQs Annular Material <br /> Depth from Borehole Typs Material wall Outside Screen Slot Size Depth from <br /> Surface Diameter Thickness Dbame'er Type if Any Surface FIII Deacriptlon <br /> Feet to Feet Inches ._-- Inches Inches Inches Feet to Feet <br /> Attachments Certification Statement <br /> ❑Geologic Log I, :hu mdersigned,certify that this report is complete and accurate to the best of my knowledge and belief <br /> C:3g Well Construction Diagram Nan'.,, All Well Abandonment Inc <br /> Person,Firm ar Cwpotm <br /> ❑ Geophysical Log(s) _43Q;3 Fitzgerald Fitolo tSG`ordova CA 95742 <br /> Ad, s City State Lp <br /> ❑ Soil/Water Chemical Analyses 4/27/2015 848359 <br /> ❑+ Other Site Mao ISgratlL� <br /> AnaCt eddill-al Irl—al-H it swats. .r`� ! Gs7 Lice contractor Dale Signed C-57 License Number <br /> DWR 188 REV.Woos IF AE 11TIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />