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_ --------------------- _ _ -- -- _ _ - ----- <br /> i <br /> QUADRUPLICA ]cOWR USE ONLY — DO NOT FILL IN <br /> � STATE OF CALIFORNIA <br /> For Local Requirements WELL COMPLETION REPORT <br /> Page-I--of � Refer to Insfructron Fampblet STATE WELL NO tSTATION NO <br /> Owner's Well No M61 - No 5 0 3 6/r O <br /> Date Work Began 9 2? 98 Ended 9/25/98 �! V'7 LATITUDE LONGITUDE <br /> Local Permit Agency l Joaquin CEM <br /> Permit No Permit Date /5/9>"3 APNrTR r TH R <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION VERTICAL — HORIZONTAL _ ANGLE — (SPECIFY) Narne ff <br /> lib= Ellis <br /> DEPTH TO FIRST WATER 34 (Ft) BELOW SUShag,Marling Address 191 W. �i 4I07 <br /> DEPTH FROM Fresno CA 93704-2876 <br /> $uRFACE DESCRIPTION <br /> 1=1 to Ft Describe material,grain size color etc CITY STATE ZIP <br /> WFLL LOCATION <br /> 0 5 4@nd Silt Address 23:2ladvetrial Drive <br /> 5 Its qLay silt City 5b.,..�....., nn <br /> 16 13 Sandy silt County San <br /> 13 25 qay silt APN Book Page Parcel <br /> 25 T_T2___T si1C Clay ToZship '1N Range 6E Section 24or <br /> r <br /> + Lgtlttlde 3• I 54 I 23 NORTH Lorlgitlide 121 , ! I WE <br /> + I DEG MIN SEC DEG MIN SEC <br /> LOCATION SKETCH ACTIVITY (�) <br /> NORTH NEW WELL <br /> Sl <br /> MODIFICATION/REPAIR <br /> _Deepen <br /> i§ <br /> _Other(Specify) <br /> I <br /> 1 + DESTROY(De <br /> Procedures andd Materials <br /> ®Hale <br /> r Under GEOLOGICLOG ) <br /> PLANNED USE(S) <br /> �+` a (Z-) <br /> Lu MONITORING <br /> I <br /> F WATER SUPPLY <br /> I <br /> Domestic <br /> Public <br /> I + Irngataon <br /> Industrial <br /> ,^ TEST WELL <br /> + 1 � <br /> CATHODIC PROTEC <br /> SOUTH TION <br /> Illustrate or Describe Distance of Well froru Landmarks OTHER(Specify) <br /> such as Roans Buildings Fences Rivers etc <br /> PLEASE BE ACCURATE c'r COMPLETF <br /> DRILLING Rol <br /> METHOD 1cm sum FLUID N/A <br /> WATER LEVEL & YIELD OF CO-MPLETED WELL, <br /> DEPTH OF STAT/ — <br /> WATER LEVEL • l� (Ft) & DATE MEASURED .... 2 8 <br /> •2` ZA <br /> ESTIMATED YIELD' (GPM) & TEST TYPE <br /> TOTAL DEPTH OF BORING 52 (Feet) TEST LENGTH j•3 (Hrs) TOTAL DRAWDOWN NIA (Ft) <br /> TOTAL DEPTH OF COMPLETED WELL � (Peet) "May not be representative of a well's long-term yield <br /> DEPTH CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE SORE VE ._!,L' FROM SURFACE TYPE <br /> HOLEINTERNAL GAUGE SLOT SIZEDIA MATERIAL/ CE BEN <br /> {Inches) DIAMETER OR WALL IF ANY FILTER PACK <br /> GRADE MENT TONiTE FILL <br /> Ftto Ft (Inches) THICKNESS (inches) Ft to Ft (TYPE/SIZE) <br /> 0 25 9 X /Sch 2 .25 0 20 X <br /> 25 50 9 Sc 2 .25 .020 20 23 X <br /> 23 52 X #3 end <br /> 1 <br /> i <br /> ATTACHMENTS (n) CERTIFICATION STATEMENT <br /> Geologic Log ] the undersigned certify that this report Is complete and accurate to the best of my knowledge and belief <br /> — Well Construction Diagram NAME ( r? --. ! 1, i _ 1 <br /> t (PERSON FIRM OR CORPORATION) (TYPED OR PRINTED) <br /> ,.._ Geophysical Log(s) 1 1 f IV, <br /> — Soil/Water Chemical Analyses rd f �'r r STATE ZIP <br /> Other ADDRESS CITY f <br /> d <br /> A77ACATTACHADDfTlONAL INFORMATION IF IT EXISTS SigneWELL DRIL✓R/AIITHORIZED REPRESENTATIVE DATE SIGNED C57 LICENSE NUMBER <br /> DWR 188 REV 7 90 IF ADDITIONAL SPACE 15 NEEDED USE: NEXT CONSECUTIVELY NUMBERED FORM <br />