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DUPLICATE STATE OF CALIFORNIA D W R USE ONLY — DQ NOT FIL I N <br /> Driller's Copy {WELL COMPLETION REPORT <br /> F, Page 10 STATE WELL NO.75TATIpN NO. <br /> �OI�� - Refer ra Insrrvcrion Pa»rpl+Iet <br /> Owner's Well No. MW--2 No. 5 5 4 9 6 <br /> Date Work Began 9-19-95Ended 9-19-95 LATITUDE LONGITUDE <br /> Local Permit Agency San Joa in County Environmental <br /> r Permit No. 7308 Permit Date — APNITR ' TH R <br /> GEOLOGIC LOG WELL OWNER <br /> Fi ORIENTATION x VERTICAL _ HORIZONTAL —ANGLE — (SPECIFY) N ame _ Boston Market <br /> DEPTH TO FIRST WATER (Ft.) BELOW SURFACE ailing Address 411 �_A3=1je, S11ite 550 <br /> DEPTH FROM San Matey California 94402 <br /> sURFACE DESCRIPTION <br /> �- <br /> Ft. to Ft. Describe nrgterial,,t;rmn as:r,color,etc. CI WELL LOCATION STATE ZIP <br /> 514 West Kettleman <br /> -19-95 <br /> Address— Dodi <br /> Well sounded for obstructions C unty San Joaquin <br /> — ;No obstructions present. A RN Book Page Parcel <br /> - Hard bottom at 80 feet. T wnship 3N Range 6E Section NE N9 14 <br /> - er at 64 feet. L titudeNORTH <br /> Longitude I � WEST Well casing pressure grouted DEG. MIN. SEC. DEG. MIN. SEC. <br /> LOCATION SKETCH ACTIVITY <br /> using neat cement one 94-pound NORTH NEW WELL <br /> r ' bag of neat cement to 6 gallons MODIFICAnON1REPA[R <br /> of water) B � <br /> —...Deepen <br /> :Concrete cap placed over well <br /> — 'casing at feet below grade. <br /> —Other{Sgecity3 <br /> — 'Surface asphalt patched back toMwZ XDESTAOY(Describe <br /> -!,grade, flush with parking lot. —Procedures andMetertais <br /> ' <br /> Under"GEOLOGIC LOG') <br /> N N PLANNED USE(S) <br /> lu <br /> 3 LU MONITORING <br /> WATER SUPPLY <br /> ` Domestic <br /> .3.. r�, _ Public <br /> — Irrigation <br /> i <br /> � <br /> Industrial <br /> ' — "TEST WELL" <br /> f.-- .—.. CATHODIC PROTEC- <br /> SOUTH TION <br /> I Ifustrafe or Describe Distance of Well from Landmarks — OTHER(Specify) <br /> r ; such as Roads,Buildings,Fences,Rivers,etc. <br /> LEASE BE ACCURATE & COMPLETE. <br /> 4 <br /> DF ILLING NA <br /> METHOD FLUID <br /> 1 WATER LEVEL & YIELD OF COMPLETED WELL <br /> DEPTH OF STATIC 54 g-19-95 <br /> w TER LEVEL (Ft.) & DATE MEASURED <br /> E TIMATED YIELD* -(GPM) R TEST TYPE <br /> ( TOTAL DEPTH OF BORING (Feet) TEST LENGTH (Hrs.) TOTAL DRAWDOWN (Ft.) <br /> f TOTAL DEPTH OF COMPLETED WELL (Feet) *.Way not be representative of a well's long-term yield. <br /> DEPTH CASINGS) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE BORE- TYPE ✓1 FROM SURFACE TYPE <br /> HOLE INTERNAL GAUGE SLOT SIZE <br /> DIA. = x MATERIAL/ CE- BEN- <br /> ) w io DIAMETER OR WALL IF ANY FILTER PACK <br /> BEN- <br /> (inches) c,; J GRADE MENT TONITE FILL <br /> Ft. to Ft. y �� (Inches) THICKNESS (Inches) Ft. to Ft. ✓ ✓ (TYPElSIZE) <br /> See Atta Well Construction See I tta Well <br /> Diacyri Const ruction Di ram <br /> F <br /> ATTACHMENTS (✓) CERTIFICATION STATEMENT <br /> I,the undersigned,certify that this report is complete and accurate to the best of my knowledge and belief. <br /> ..�.. Geologic Loft <br /> X Well Construction Diagram NAME Kram & Ass iates, Inc. <br /> (PERSON, FIRM. OR CORPORATION) ( PED OR PRINTED) <br /> Geophysical Log(a) M� <br /> F Soil/Water Chemical Analyses 215 West DakotaAvenue Clovis CA 93612 <br /> PF�t ADDRESS CITY STATE ZIP <br /> Other )kj �/-°/� o <br /> - ATTACH ADDIT70NAL INFORMAT70N. IF tT EXISTS. Signed - t SW 9' 7,^7- • 499908 <br /> WELL DRILLER/AUT IZ£D REPRESEN ATI DATE SIGNED C-57 LICENSE NUMBER <br /> r)WR 188 REV.7-9p IF ADDITIONAL SPACE IS NEEDED, USE NEXT�C NSEC IVELY NUMBERED FORM <br />------------------L__...—...----------------------------------------- ---- ______-------- --- ----___J.__,�.` <br />