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ORIGINAL STATE OF CALIFORNIA D W R USE O N L — no <br /> O 7 FAL <br /> File with DWR WELL COMPLETION REPORT at A t•51 di-/l.,El 21X In ) <br /> Page_of Refer to Instruction Pamphlet STATE WELL NO./STATION NO. <br /> Owner's Well No. No El ❑ <br /> Date Work Began S e�4, 19 9 7 Ended ^ �/ LATITUDE LONGRUDE <br /> Local Permit Agency San Joaquin Co. Health De t. <br /> Permit No. 01.3540-1,1/01 0 5 41 — rmit Date APNiTASIOTHER <br /> GEOLOGIC LOG !WELL OWNER <br /> ORIENTATION (•!) __Ix_VERTICAL <br /> yy�—HORIZONTAL _ANGLE —(SPECIFY) <br /> DEPTH TO/XISYl VATER 144(FL)BELOW SURFACE — <br /> DEPTH FROM <br /> SURFACE DESCRIPTION <br /> Ft. to Ft. Describe material,grain size,color,etc. WELL LOCATION <br /> 0 2 Top Soil Address 23485••Hapc6ri Rd . <br /> 2 14 Clay „ city 1~i^acy <br /> 14 ; 27 Sand County San, Jhaa�lli n <br /> 27 30 Clay APN Book Page Parcel <br /> 30 32 Sand <br /> ToAswp. Range Section <br /> 32 ' 4 5 C I ay Latitude I NORTH Longitude WEST <br /> 45 48 , Sand DEO. MIN- SEC. DEG. MIN. SEC. <br /> 1 � <br /> c� , LOCATION SKETCH ACTIVITY (2L)— <br /> 4 O 5C 57 C 1 d NORTH NEW WELL <br /> 55 5/ ' - SCI n d •��, MODIFIGATIONIREPAIR <br /> 57 ; 93 ; CIay- & 'Shal•e !'JELL ABANDOt'I LENT <br /> 93 � 95 � ':Sand. ' - _.______-�__=_== _DeePea <br /> C. _Other(Specify) <br /> 95 102- 1 (I{I _ �i;-:onite/Bensea <br /> 102 10 4 Sand _.5 t o t t o ria of Well .L DESTROY(Deserfbe <br /> 10 4 ; 10 5 C 1 a Under°�FOLOGICLoa'•, <br /> 105 107 Sand & 'Gravel ST .-L DIAMETER r PLANNED USE(S) <br /> 107 162 C,1 a & Shale W MONITORING <br /> 162 ; 166 Clay <br /> Sand <br /> +a n d WATER SUPPLY <br /> 1 6 6 177 I C l a r /- �� X Domestic <br /> 177 179 Fine Sand // Public <br /> 179 ; 238 ; Blue Clay & Shale — Irrigation <br /> 238 244 Fine Sand with Shale Streaks — industrial <br /> 244 313 Blue Clay "TEST WELL" <br /> 3 1 3 3 1 5'; Sand — CATHODIC PROTEC- <br /> 315 ' 330 C l a SOUTH TION <br /> Ilinstrate or Describe Distance of Well from Landmarks OTHER(Specily) <br /> 330 334• ; Sand such as Roads,Buildings,Fences,Rivers,etc. , <br /> 335 ' Clay a <br /> 334- <br /> PLEASE BE ACCURATE& COMPLETE. <br /> ' <br /> DRILLING <br /> 335 ; 338 ; Sand METHOD Mud Rotary FLUID bentonite/Water <br /> 338 340 : Clay WATER LEVEL & YIELD OF COMPLETED WELL <br /> DEPTH OF STATIC <br /> WATER LEVEL (Ft.) & DATE MEASURED <br /> ESTIMATED YIELD* (GPM) & TEST TYPE <br /> TOTAL DEPTH OF BORING 340 (Feet) TEST LENGTH (Hrs.) TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL-11-0 (Feet) 'Nfay not be representarive of a well's long-teen yield. <br /> DEPTH CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE BORE TYPE ✓ FROM SURFACE TYPE <br /> HOLE — INTERNAL GAUGE SLOT SIZE <br /> DIA. x z a MATERIAL( CE- BEN- <br /> DIAMETER W oto d GRAD£ DIAMETER OR WALL IF ANY MENT TONITE FILL FILTER PACK <br /> Ft, to Ft. m ti �a (Inches) THICKNESS (inches) Ft. to Ft. (✓ ) (✓ ) (✓) (TYPEISIZE) <br /> 0 120• 1211 X PVC 61f 160CI 0 200 1 X <br /> 1Z0,41ZQ,4 220 I I ll 200C 1 200 340 X Sand Gravel <br /> 20 300 1211 PH fi 11 <br /> II ll <br /> ATTACHMENTS CERTIFICATION STATEMENT <br /> Geologic Log I,the undersigned,certify that this report is complete and accurate to the best of my knowledge and belief. <br /> — <br /> — Well Construction Diagram NAME H E N N I N G S BROS . DR-ILLING CO. , I N G. <br /> (PERSON, FIRM, OR CORPORATION) (TYPED OR PRINTED) <br /> — Sol/Geophysical 3525 PELANDALE AVE. MODESTO CA 95356 <br /> _ Sol/Water Watar Chemical Analyses <br /> ADDRESS CITY STATE ZIP <br /> Other If1 p <br /> ATTACH ADDITIONAL INFORMATION. IF IT EXISTS. Signed ) -c if SEPT.1 5,1 97 290813 <br /> 8 <br /> WELL DRILLER/AUTHORIZED REPRESENTATIVE DATE SVGNED C57 LICENSE NUMBER <br /> ' D1VR188REV.7-g0 IF ADDITIONAL SPACE IS NEEDED, USE NEXT CONSECUTIVELY NUMBERED FORM �� r <br />