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DUPLICATE STATE OF CALIFFR 'IA <br /> DWR USE ONLY — 00 NOT FILL IN <br /> FDriller's Copy WELL COMPLETIO REPORT <br /> I Page 1 Of 1 Refer to Instruction Pa phler � STATE WELL NO.fSTATION NO, <br /> Owner's Well No. MW_1 Nc• 55C, 495 <br /> Date Work Began 9-19-95 Ended 9-13-95 LATITUDE LONGITUDE <br /> ' Local Permit Agency San Joaquin Count Environmental Health Dept. <br /> Permit No. 7308 Permit Date 9-18--95 APNlTR <br /> GEOLOGIC LOG WELL. OWNER <br /> ORIENTATION (�) -i— VERTICAL — HORIZONTAL —ANGLE —(SPECIFY) Mime Boston Mares <br /> DEPTH TO FIRST WATER (Ft.)BELOW SURFACE Mailing Address 411 BOrel Avenue, <br /> /� Suite 550 <br /> DEPTH FROM San Mateo California 94402 <br /> SURFACE DESCRIPTION <br /> CI - - STATE ZIP <br /> Ft. to Ft. Describe material,grain size,calor,etc. � WELL L 0 C A T I 0 N <br /> Address TnTest Kettleman <br /> 9:49-95 City Lod <br /> Well sounded for obstructions C unty San Joaquin <br /> — ; No obstructions present A N Book Page Parcel <br /> F' - Hard bottomat. 80 feet.. orNE NE <br /> Water at set <br /> Township <br /> Range 6E Section 14 <br /> ' or <br /> L titude I NORTH Longitude WEST <br /> Well casing pressure grouted <br /> DEG. MIN, SEC. DEG. MIN. SEC. <br /> { ; LOCATION SKETCH ACTIVITY (r) <br /> using neat cement one pound NORTH <br /> NEW WELL <br /> bag of neat cement to 6 gallons <br /> of-Water MODIFICATIONlREPAlR <br /> a _ Deepen <br /> OFxicre cap pla&ia over well —Other(Specify) <br /> ' <br /> casing ati3 feet below grade. <br /> Surface asphalt patched back to _ X <br /> � �DESTROY(Describegra e, flus with parking lot. Procedures andMatarlars <br /> Under"GEOLOGIC LOG'7 <br /> PLANNED USE(S) <br /> W <br /> UJ MONITORING <br /> F-� <br /> WATER SUPPLY <br /> f — Domestic <br /> — public <br /> r � Irrigation <br /> Industrial <br /> T i � l�t:r�g lel�t:+WLF <br /> _TEST WELL•, <br /> CATHODIC PROTEC- <br /> SOUTH TION <br /> r I lusirate or Describe Distance of Well from Landmarks — OTHER(Specify) <br /> + sAch as 11oady,Buildings,LEASE BE ACCURATEFences, <br /> eCOMPLETE. <br /> OF ILLING NA <br /> ME7HOD FLUID <br /> p WATER LEVEL & YIELD OF COMPLETED WELL <br /> DEPTH OF STAT 64 9-19-95 <br /> WATER LEVEL (Ft.) & DATE MEASURED <br /> ESTIMATED YIELD (GPM) & TEST TYPE <br /> i TOTAL DEPTH OF BORING (FTET LENGTH (Hrs.) TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL 10 (Feet) 'j 4ay nor be representative of a well r long-term yield. <br /> DEPTH CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE BORE- <br /> HOLE TYPE ✓ FROM SURFACE TYPE <br /> INTERNAL GAUGE SLOT SIZE <br /> DIA. z d MATERIAL/ F ANY CE <br /> FTo <br /> N- <br /> Ft. to Ft. (Inches) m ? J GRADE DIAMETER THICKNESS OR WALL !(n he) Ft. to Ft. MENTITE FILL FILTER PACK <br /> H o (:) (�) (TYPE/SIZE) <br /> Construction See Attachel Well <br /> Diagram s ct3 n agram <br /> t <br /> t ATTACHMENTS (✓) CERTIFICATION STATEMENT <br /> { <br /> Geologic Lop I,the undersigned, certify that this report is complete and accurate to the best of my knowledge and belief. <br /> R-) Well Construction Diagram NAME Krazan & Asssates, Inc. <br /> (PERSON, FIRM, OR CORPORATION) (TYPED OR PRINTED) <br /> Geophysical Log(s) 215 West Dakota Avenue Clovis CA 93612 <br /> I SoiI7Wa1 Che��migg�1 Analyses <br /> dL1A.iL ADDRESS ` CITY STATE ZIP <br /> 7—7- f 499908 <br /> ATTACH ADDITIONAL INFORMATION. IF IT EXISTS. Signed _ - '� <br /> WELL DRILLER/A TED REPRESE A VE Z DATE SIGNED C-57 LICENSE NUMBER <br /> DWR 188 REV.7-90 IF ADDITIONAL SPACE IS NEEDED, USE NEXT OCIKSECIVIVELY NUMBERED FORM <br />