Laserfiche WebLink
'The free Adobe Reader may be used to view and complete this form. However,software must be purchased to complete,save,and reuse a saved form. <br /> File Original with DWR State of California OWRUW Onl -DO NWIFie In <br /> Well Completion Report <br /> Page 1 or 1 RerO- e0slmaion Pamphlet IHumbadsi[e Number <br /> OwneYs Well Number MW-11 No. e0120514 N W - <br /> Date Work Began 07/15/2010 Date Work Ended 7/15/2010 Lamude Longitude <br /> Local Permit Agency San Iran 'n county Envirommnetal Health Department <br /> Permit Number SR059570 Permit Date 12/11/09 APNrFRS/Other <br /> ,Geologic Log Well Owner <br /> Orientation OVertical O Horizontal OAngle Speciry. Name Shell Oil Products US <br /> Drilling Method Hollow Stem Au er Drilling Fluid Mailing Address 20945 South Wilmington Avenue <br /> Depth from Surface Description CI Carson State Chi 90810 <br /> Feet to Feat Describe material, rain size,color,etc <br /> c avenrcweLLL v ` h Well Location <br /> Address Cordes Ranch <br /> CityTracy County San Joaquin <br /> Latitude N Longitude <br /> Deo. Min. Sec, Dao. Min. Sec. <br /> Datum Decimal Lat. Decimal Long. <br /> APN Book Page_ Parcel <br /> _ --- - Townshi Range— Section <br /> Location.Sketch Activity <br /> r Sketch muel 0e drown. hand after tvre,is rinted. <br /> Q New Well <br /> —�- — - 0 Modification/Repair <br /> O Deepen <br /> ---------- — 0Othef <br /> —" � 0 Destroy <br /> � cearee Paaa m mae,um <br /> .—_ _ I �a,rreeaocic ioc <br /> -' Planned Uses " <br /> 0 Water Supply <br /> �'------------------- ----I---- ❑Domestic ❑Public <br /> �^ `• <br /> ❑Irrigation ❑Industrial <br /> 0 Cathodic Protection <br /> 0 Dewatering <br /> 0 Heat Exchange <br /> 0 Injection <br /> 00 Monitoring - <br /> � I Remediation <br /> 0 Splurging <br /> 0 Test Well <br /> 0 Vapor Extraction <br /> . oesare weealn aista�a.enrmm me <br /> o. seer <br /> krima <br /> nasm.em ammemeue wanaw layrreurv7. DOther <br /> r.ra e..LLerm..e.�IM. <br /> Water Level and Yield of Com letetl Well <br /> Depth to first water 37 (Feet below surface) <br /> Depth to Static <br /> Water Level (Feet) Date Measured <br /> Total Depth of Boring 45.5 Feet Estimated Yield (GPM) Test Type <br /> Total Depth of Completed Well 45 Feel Test Length (Hours)Total Drawdown_(Feet) <br /> *May not be representative of a well's long term yield. <br /> - <br /> ,Casings Annular Material <br /> Depth from Borehole a l Wall Outside Screen Slot Size Depth from <br /> Surface Diameter Type Material Thickness Diameter Type IfAny Surface Fill Description <br /> Feet to Feet Inches Inches Inches inches Feet to Feet <br /> 0 130 8 JBIank. PVC Sch.40 1 12 1 1 0 26 Cement Portland cement <br /> 30 145 8 1 Screen I PVC Soh.40 1 12 IMilledSlots 0.020 26 28 aenlonite <br /> 28 45 Filter Peck 2/12 sand <br /> Attachments'. - Certification Statement <br /> ❑Geologic Log 1,the undersigns rti al 1 cam lets and accurate to the best of my knowledge and belief - <br /> ❑Well Construction Diagram Name <br /> ❑Geophysical Log(s) 'VIr CA <br /> ❑SolVWater Chemical Analyses g qr l O wale roT/��z+tL <br /> ❑Other Signed if !f J `] <br /> AtbdL adds ional Information If11 eAsts. O67 sed Water W DOdImcIM ate I ned C-$7 License Number <br /> MR 168 REV.1120M IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />