Laserfiche WebLink
DUPLICATE STATE OF CALIFORNIA —DWF1 V3E ONLY — 0 0 NOT F I I N <br /> Driller''s Copy ("VELL COMPLETION REPORT E � 1 1 1 i I I I III <br /> - Page 1 OF 1 ` + Rcfer to lustruction Pa uiphlri STATE WELL NO./STATION N0, <br /> Owner's Well No._.M[L-&. - No. 550497 ❑ I I I ❑ <br /> Date Wort: Began 9-19-95 , Ended 9-19-95 LATITUDE LONGITUDE <br /> Local Per Agency San Joaquin County Environmental <br /> No. <br /> 308 - <br /> APNITFISIOTHER <br /> 1 Permit 1\o. Permit Date <br /> GEOLOGIC LOG WELL. OWNER <br /> m <br /> ORIENTATION (✓ ) X VERTICAL — HORIZONTAL _ ANGLE — (SPECIFY) N e ----Boston Market <br /> Avenue, Suite 550 <br /> DEPTH TO FIRST WATER (Ft.) BELOW SURFACE M ilinpr�AMateo <br /> '[ <br /> DEPTH FROM J g California 94402 <br /> SURFACE DESCRIPTION <br /> CITY STATE ZIP <br /> Ft. to Ft. Describe material,grain size,color,etc. WELL LOCATION <br /> Address 14 Nest Kettleman <br /> 9-19-95 Ci- loft <br /> - rr we a a c tuttty San Joaquinep o ee using ow t <br /> A N Book Page Parcel <br /> :sfein auger. Township Flange 6E Section NE NE 14 <br /> El7ackfi boring o grade by., or <br /> Latitude t NORTH Longitude I I WEST <br /> e tnroughthe hollow, stun DEG. MIN. SEC. DEG. MIN. SEC. <br /> LOCATION SKETCH ACTIVITY (-) <br /> ;alzgear uS ng nes C".eR'teTl one NORTH NEW WELL <br /> pouna g of eerito <br /> ga cim O wa � � MODIFICAnONIREPAIR <br /> ' ' _ —Deepen <br /> ' ..�Other(Specify) <br /> - � t <br /> DESTROY(Describe <br /> ' ' _ �• ]. Procedures and Materials <br /> ' Under"GEOLOGIC LOG") <br /> I- I- PLANNED USES) <br /> V) <br /> L MONITORING <br /> ' ' •_R•• WATER SUPPLY <br /> I r <br /> 1 Flt�•{p <br /> o — <br /> T Domestic <br /> Public <br /> I I <br /> Irrigation <br /> _ Industrial <br /> "TEST WELL" <br /> CATHODIC PROTEC• <br /> SOUTH TION <br /> I lustrate or Describe Distance of Well from Landmarks — OTHER(Specify) <br /> s ch as Roads,Buildings,Fences,Ricers,etc. <br /> ' LEASE BE ACCURATE& COMPLETE. <br /> � I <br /> DF ILLING NA <br /> METHOD FLUID <br /> I WATER LEVEL & YIELD OF COMPLETED WELL <br /> DEPTH OF STATI(unlaICAM <br /> WATER LEVEL (Ft.) & DATE MEASURED <br /> EE TIMATED YIELD' (GPM) & TEST TYPE <br /> TOTAL DEPTH OF BORING TEST LENGTH (Hrs.) TOTAL DRAWDOWN (Ft.) <br /> TOTAL (Fee#DEPTH OF COMPLETED WELL II (Feet) * ay not be representative of well's long-term yield. <br /> DEPTH CASING(S) DEPTH ANNULAR MATERIAL <br /> J FROM SURFACE BORE HOLE —TYPE ✓ FROM SURFACE TYPE <br /> INTERNAL GAUGE SLOT SIZE <br /> DIA. ,� z MATERIAL/ CE- BEN- <br /> (Inches) z ;i a DIAMETER OR WALL IF ANY FILTER PACK <br /> Ft. to Ft. 5 h GRADE (Inches) THI(iKNE53 (Inches) Ft. to Ft. MENT TONITE FILL (TYPElSIZE) <br /> - (":- (-' ) () <br /> �. <br /> -inch ame PVC welA casing, Total Deptft o4 we 1: 70 feet <br /> other construction spacificatEn unkenown. <br /> L IF <br /> �s I <br /> ATTACHMENTS ('') CERTIFICATION STATEMENT <br /> �r Geologic Log <br /> I,the undersigned,certify that this report is complete and accurate to the best of my knowledge and belief. <br /> 4 Well Construction Diagram NAME Krazan & lisisociates, Inc. <br /> (PERSON, FIRM, OR CORPORATION) (TYPED DR PRINTED) <br /> ...._ Geophysical Log(s) 215 west Dakota Avenue Clovis CA 93612 <br /> Soil/Water� emical clyses• � ��� ADDRESS CITY � STATE ZIP <br /> Other �" Z7"' y 499908 <br /> F, <br /> ATTACH ADDITIONAL INFORMATION. IF IT EXISTS. Signed <br /> WELL DRILLER ORIZED REPRES TIV DATE SIGNED G-57 LICENSE NUMBER <br /> NE <br /> DWR 188 REV.7-90 IF ADDITIONAL SPACE IS NEEDED, USE NEXT C UTIVELY NUMBERED FORM <br />_------- ------'-_-------------------------------------t-------------------------------------`-�- -- <br />