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OUADRUPLICATE 7 STATE Of' CALII ORNIA D W R U S E ONLY D O N T F f L L I N <br /> For Local Requirements WELL COMPLETION REPORT <br /> Page OF 1 Defer to Instruction Pamphlet STATE WELL NO!STATION NO <br /> Owner's Well No "'"2 No <br /> Date Work Regan 9/23/98 Ended 9/251 LATITUDE ❑ LONGITUDE <br /> Local Permit Agency San Joaquin dtFb <br /> Permit No SR016479 Permit Date 6/15/98 1 APN17RSIOTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION (.!!L) � " �� <br /> VERTICAL �,_ HORiZgNTAL _ ANGLE �,,._ (SPECIFY) Name <br /> DEPTH TO FIRST WATER (Ft) BELOW SURFACE Mailtn Address Ivi W <br /> D <br /> .... <br /> R ACEM resin OA 83704-28 <br /> DESCRIPTION <br /> Ft to Ft Describe be material,grasize,color,etcCITY <br /> WELL LOCATION STATE ZIP <br /> 0 2 54ndy silt Address 212 Industrial Drive <br /> 2 14 Silt Clay City Sutra, CA <br /> 14 16 §ygoy clay County �TUS <br /> 16 AM I <br /> -- S l$ C APN Book Page Parcel <br /> Township 1� Ran a �� Section y4 yy <br /> Latitude NORTH +21 16 L9 WEST <br /> i Longitude <br /> ' DEG MIN SEC DEG MIN SEC <br /> LOCATION SKETCH ACTIVITY (�} <br /> NORTH ?L NEW WELL <br /> i <br /> MODIFICATIONt REPAIR <br /> Nom,,... ✓'" Deepen <br /> Other(Specify) <br /> DESTROY tDescnbe <br /> Procedures and Materials <br /> T r Under GEOLOGICLOG ) <br /> t r PLANNED USE(S) <br /> m <br /> w x (f) <br /> 1 , � MONITORING <br /> uJ-Z <br /> , # WATER SUPPLY <br /> _ Domestic <br /> 1p - Public <br /> Irrigation <br /> - Industnat <br /> TEST WELL <br /> ' 1 - CATHODIC PROTEC <br /> TION <br /> SOUTH TION <br /> Ulmratf or Descrtbe Distance of Well from I andmarks — OTHER(Specify) <br /> such as Roads Buildings Fences Rivers etc <br /> i <br /> PLEASE BE ACCURATE & COMPLETE <br /> DRILLING ft11ov sty _ <br /> METHOD—. ._._ _ `FLUID <br /> WATER LEVEL & YIELD OF COMPLETED WELL <br /> DEPTH 98 <br /> WATER OLEVEL ATICe'�0 (Ft) & DATE MEASURED <br /> ESTIMATED YIELD" (GPM) & TEST TYPE <br /> TOTAL DEPTH OF BORING. (Fe TEST TEST LENGTH (Hrs) TOTAL DRAWDOWN (Ft) <br /> TOTAL DEPTH OF COMPLETED WILL — *� (Feet) *May not be representative of a well's 1071g-term yield <br /> DEPTH CASINC(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE BOE HOLETYPE ! FROM SURFACE TYPE <br /> DIA Y z o MATERIAL/ INTERNAL GAUGE SLOT SIZE CE B£N <br /> Ft ie Ft (Int nes) zM a DIAMETER OR WALL IF ANY MENT TOf(ITL FILL <br /> a o� J GRADE FILTER PACK <br /> m v cn� J (Inches) THICKNESS (Inches) Ft to Ft <br /> d P 713 (L) (4) ('!} (TYPE/SIZE) <br /> i <br /> 8 X <br /> 30 52 X #3 Sand <br /> ATTACHMENTS CERTIFICATION STATEMENT <br /> — Geologic Log I the undersigned certify that this report Is complete and accurate to the best of my knowledge and belief <br /> -- Weil Construction Diagram NAME k r r / fI u <br /> (PERSON FIRM OR CORPORATION) (TYPED OR PRINTED) <br /> Geophysical Log(s) k <br /> Soil/Water Chemical Analyses <br /> ADDRESS CITY <br /> STATE ZIP <br /> --- Other <br /> ATTACH AOp1TlONAL INFORMATION IF IT EXISTS Signed �- 3 I <br /> WELL DRILLER/AUTHORIZED REPRESENTATIVE DATE SIGNED C 57 LICENSE NUMBER � <br /> DWR IN REV 7 W IF ADDITIONAL SPACE IS NEEDED USE NEXT CONSECUTIVELY NUMBERED FORM <br />