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3500 - Local Oversight Program
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PR0545274
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Last modified
1/31/2020 6:05:52 PM
Creation date
1/31/2020 4:38:13 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
FIELD DOCUMENTS
RECORD_ID
PR0545274
PE
3528
FACILITY_ID
FA0018313
FACILITY_NAME
JOES TRAVEL PLAZA
STREET_NUMBER
15688
Direction
S
STREET_NAME
HARLAN
STREET_TYPE
RD
City
LATHROP
Zip
95330
APN
19620077
CURRENT_STATUS
02
SITE_LOCATION
15688 S HARLAN RD
P_LOCATION
07
P_DISTRICT
003
QC Status
Approved
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EHD - Public
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. 'The free Adobe Reeder maybe used to Waw and compldte'lhls form. However,software must be purchased to complete,save,end reuse a saved farm. <br /> FIIe Original with DWR State of California DWR Use OM —Do Not Fill In <br /> Well Completion Report <br /> `. Page 1 Of 1 aek.f0lnsnuoion Parrwaar State Well NumberlSite Number <br /> Ownefs Well Number M-1 No. e0095617 <br /> Date Work Began 07/20/2009 Date Work Ended 7/20/2009 - Letftude Lon nude <br /> Local Permit Agency San Joaauin County Environmental Health Department <br /> Permit Number 57817 Permit Date 7/15/09 APNrtaslomer <br /> Geologic Lo _ Well Owner <br /> Orientation O Vertical O Horizontal OAngle Sperry Name Dalwinder Ohoot <br /> Drilling Method Drilling Fluid <br /> Mailing Address 15600 S.Harlan Road <br /> Depth from Surface Description <br /> Feet m Feet Describe material rain size color,at: city Lathrop State CA 7i <br /> Well destroyed b overdrillin to total de th. Well Location <br /> Address 15688 S. Harlan Road <br /> city Lathrop County San Joaquin { <br /> Latitude N Longitude <br /> Dec. Min. Sec. Dia, Min Sec. <br /> Datum Decimal Let. Decimal Long. <br /> APN Book 196 Page 200 Parcel 17 <br /> Township Ran a Section <br /> Location Sketch Activity <br /> Sketch mmammawnb hard efOx fomilc tea. New Well f <br /> North O Modification/Repair <br /> O Deepen <br /> O Other <br /> Q Destroy <br /> Dewe.OL.C.a <br /> aria.,roeotoac too• <br /> Planned Uses <br /> O Water Supply <br /> ❑Domestic [_]Public <br /> w Dlrrlgetlon ❑Industrial <br /> O Cathodic Protection <br /> O Dewatering <br /> O Heat Exchange <br /> O Injection <br /> O Monitoring <br /> O Remediation <br /> O Spangling <br /> South O Test Well <br /> lameswe®ee.mune.or wen kem,.Me,ansae..snn.r. O Vapor Extraction <br /> mw...m.m.mmam.P,aloe.iasnr aw.r eiueve.w_ O Other <br /> PMee.M.v 29 IM— <br /> Water Level and Yield of Completed Well <br /> Depth to first water. (Feet below surface) <br /> Depth to Static <br /> Water Level (Feet) Date Measured <br /> Total Depth of Boring 16 Feet Estimated Yield' (GPM) Test Type <br /> Total Depth of Completed Well Feet Test Length (Hours) Total Drawdown_(Feet) <br /> *May not be representative of a well's Ion term yield. <br /> Casings Annular Material <br /> Depth from Borehole Wall Outside Screen Slot Size Depth from <br /> Surface Diameter Type Material Thickness Diameter Type If Any Surface Fib Description <br /> Feet to Feet inch" Inches Inches Inchon Feet to Feet <br /> Attachment8 Certification Statement <br /> ❑Geologic Log I,the under l9ned,ceitlryry that this report Is complete and accurate to the best of my knowledge and belief <br /> ❑Well Construction Diagram Name Woodward Drilling <br /> ❑ Geo Logi(s) per$..R aorcorporaban <br /> Geophysical L (s) '550 River Road RIO Vista CA 94571 <br /> ❑S&IIINVatef Chemical Analyses Adatars City spas zip <br /> ❑Other Signed &Maes �wr/bsraQr..,r�cl 07-2f OS 710079 <br /> Ansa,eaenlan.a Ito rlt etlim O-57Ucencea wai Contractor Date S' nsd C-57 License Number <br /> DWR IN REV.112009 IF ADIXnONAL SPACE IS NEEDED,USE NEVr CONSECUTIVELY NUMBERED FORM - <br /> 1 <br />
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