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OUADI"JPLICATE STATE. OF CALIFOI(\IA DWR USE ON L Y — 00 N O T FILL IN <br /> Fir Lc&al Requirements WELL COMPLETION REPORT 1 1 1 1 1 1 -A_-A 1 i I <br /> '`vSTATE WELL NO./STATION NO. <br /> Page—of Rr/er ru InJnunron Pamphlet <br /> Owner's Well No. u No. f60963 <br /> � C <br /> Jan. 16. 1996Ended Mar 27 199 LATITUDE LONGITUDE <br /> Date Work f3c•gan s <br /> Local Permit A t San Joe uin Co. Health Sept. -it I I I I I I I I I I I <br /> Permit No. F4'4 Permit Dater AP/TRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION (�) X VERTICAL _ HORIZONTALANGLE _(SPECIFY) Name Ralph Firkins/ C/o Fidelity National <br /> DEPTH TO FIRST N'.ATER /a-,.t.) BELOW SURFACE: IVailiylb+Ac�(3ress 3 5 We F St. qt Title Cc <br /> DEPTH FROM ba> dale Ca 95361 <br /> SURFACE DESCRIPTION <br /> Ft. to Ft. L)escribe material,grain size,color,etc. CITY STATE ZIP <br /> N'F�LL LQCA�IQN <br /> Address uaS R C <br /> -6 Sand— o. Add Stockton171Y55 <br /> -- County an Joaquin <br /> 9- earts <br /> PN Book Page Parcel <br /> ay Or <br /> Township Range Section <br /> 129 134 Sand or <br /> Latitude NOR TM Longitude WES <br /> 16 1 ay <br /> DEG. MIN. SEC. DEG. MIN SEC. <br /> LOCATION SKETCH ACTIVITY (')- <br /> NORTH _ NEW WELL <br /> 149 169 Clay WELL ABANDONMENT MODIFICATION/REPAIR <br /> 109 184 Sandeasesssessesesse _Deepen <br /> 104 197 Clay —Other(Species) <br /> 197 ; 203 Sand 0-44 ug Down <br /> 203 213 ' 0-60 <br /> Bentonit <br /> e DESTROY(Describe <br /> a60Procedures and <br /> Bottom of Well Under"GEOLXICLOG <br /> r PLANNED USE(S) <br /> 3 6" STEEL DIAMETER w _ MONITORING <br /> WATER 9fPPLY <br /> _ Domestic <br /> _ Public <br /> - Irrigation <br /> y�Y► <br /> _ Industrial <br /> _ "TEST WELL" <br /> _ CATHODIC PROTEC <br /> SOUTH TION <br /> Ilbutraie or Describe Distance of Well from Landmarks — OTHER(Specify) <br /> such as Roa(h•Ruildings,Fences.Rivers,etc. <br /> PLEASE BE ACCURATE & COMPLETE. <br /> DRILLING Mud Rotary Bentonite/Water <br /> METHOD FLUID <br /> RATER LEVEL h YIELD OF COMPLETED WELL — <br /> DEPTH OF STATIC <br /> WATER LEVEL (Ft.) & DATE MEASURED <br /> 04 04 ESTIMATED YIELD' (GPM) & TEST TYPE <br /> TOTAL DEPTH OF BORING (FVb5 TEST LENGTH (Hrs.) TOTAL DRAWDOWN (FL) <br /> TOTAL DEPTH OF COMPLETED WELL J Fert) 'May not be representative of a well's long-term yield. <br /> DEPTH CA SINC(S) DEPTH ANNULAR MATERIAL. <br /> FROM SURFACE BORE- TYPE ' FROM SURFACE TYPE <br /> HOLE — INTERNAL GAUGE SLOT SIZE <br /> CE- BEN- <br /> (Inche�s) W z¢ d MATERIAL/ DIAMETER OR WALL IF ANY FILTER PACK <br /> a ;� v GRADE MENT TONITE FILL <br /> Ft. to Ft. H cg (Inches) THICKNESS (Inches) Ft. to Ft. (� ) (� ) (� ) (TYPE/SIZE) <br /> W <br /> 185 205— 12" PVC 6" 1605ch Sureen 100 ;205 x ffdi <br /> ATTACHMENTS (✓) — CERTIFICATION STATEMENT <br /> I,the undersigned,certify that this report is com lete and accurate to the best of my knowledge and belief. <br /> — Geologic Log KENNINGS BROS. DRILLING CO. . INC. <br /> Well Construction Diagram NAME <br /> �rr (PERSON, FIRM. OR CORPORATION) (TYPED OR PRINTED) <br /> Geophysical Logs) 3525 PELANDALE AVE. MODESTO CA 95366 <br /> Soil/Water Chemical Analyses <br /> ADDRESS CITY STATE ZIP <br /> — <br /> Other ' ' � . L t \ a MAR.26.19% 290813 <br /> ATTACH ADDITIONAL INFORMATION. IF IT EXISTS. Signed } <br /> WELL DRILLER AUTHORIZED REPRESENTATIVE DATE SIGNED CSI LICENSE NUMBER <br /> DDR IMMREA 7-90 IF ADDITIONAL SPACE IS NEEDED, USE NEXT CONSECUTIVELY NUMBERED FORM <br />