Laserfiche WebLink
QUADRUPLICATE STATE OF CALIFORNIA D W R US N <br /> For LCal R, quirements WELL COMPLETION REPORT STATE WELL NO./STATION NO. <br /> Page4 of Refer to Instruction Pamphlet 1- 1111 <br /> El 71 <br /> Owner's Well No. S"'. lg� No' 500533 LATITUDE LONGITUDE <br /> Date Work Began nde <br /> Local Permit A q� 115 oagt23.n County n- ronlsental HeMt <br /> Permit No. 536 Permit Date 01 L14111,try P t <br /> jRSiOTjJER <br /> GEOLOGIC LOG WELL OWNER <br /> x Frontier Transportation, Inc. <br /> ORIENTATION (✓) VERTICAL _ HORIZOYy1L ANGLE ,.�(SPECIFY) Name <br /> DEPTH TO FIRST WATER ♦ (Ft.) BELOW SURFACE. DAailjt Address <br /> DEPTH FROM ��,:;RRll,,ii.44 CA 9171ti <br /> SURFACE DESCRIPTION <br /> CITY STATE ZIP <br /> Ft. t D scribe material, sin size,color,etc. <br /> Eibk&CATION <br /> .94 5 rureff <br /> Addrek gray— ss— <br /> ;&3 <br /> • ' sandy; very Tracy <br /> City <br /> San jusquin <br /> County <br /> liare to fine sand, x1ight] APN Book —Page 5L Parcel 16 <br /> :Moist♦ Of <br /> Township Range Section <br /> or <br /> Latitude_ NORTH Longitude WEST <br /> i i ! DEG. yMEN, SEG. DEG. MIN, SEC. <br /> LOCATION SKETCH ACTIVITY (Z.) <br /> NORTH NEW WELL <br /> 1 <br /> 9 <br /> MODIFICATION/REPAIR <br /> • <br /> _Deepen <br /> brown_tt ! ! —Other(Specify) <br /> "'tastic, 20 30% very finie to <br /> alle y / <br /> DESTROY(Describe , <br /> depth.with Procedures and Materials <br /> t i8i Under"GEOLOGICLOG') <br /> Jeft y � PLANNED USES) <br /> very fine to fine <br /> clay, wet. LU MONITORING <br /> WATER SUPPLY <br /> 141.1 IULJ^L ! Bandfgray brown, 1 <br /> - _ Domestic <br /> 9mizaticf <br /> 3181% very fine to <br /> �ine sand, very Public <br /> • <br /> 1 Irrigation <br /> — Industrial <br /> 1 <br /> "TEST WELL" <br /> r. CATHODIC PROTEC- <br /> SOUTH TION <br /> Illustrate or Describe Distance of Well from Landmarks OTHER(Specify) <br /> such as Roads,Buildings,Fences,Riners,etc. <br /> PLEASE BE ACCURATE & COMPLETE. <br /> J�L <br /> DRILLING �i:4 1�T/A <br /> METHOD FLUID <br /> DEPTH OF STFRaWA & YIELD OF COMPLEyf30F��I.� <br /> WATER LEVEL (Ft.) & DATE MEASURED250 II { <br /> ESTIMATED YIELD' (GPM) & TEST TYPE <br /> • <br /> TOTAL DEPTH OF BORING (Fgej) 5 PEST LENGTH (Hrs.) TOTAL DRAWDOWN (Ft.) <br /> e,�e• <br /> TOTAL DEPTH OF COMPLE'T'ED WELL (Feet) *May not be representative of a well's long-renal yield. <br /> DEPTH CASINGS) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE BORE- VWz_UN____E_- <br /> 4 <br /> FROM SURFACE TYPE <br /> HOLEINTERNAL GAUGE SLOT SIZE <br /> DIA. MATERIAL! CE- BEN- <br /> (Inchea) GRADE DIAMETER OR WALT. IF ANY MENT TDNITE FILL FILTER PACK <br /> Ft. to Ft. (Inches) THICKNESS (Inches) Ft, to Ft. (� ) (� ) (� ) (TYPE I SIZE) <br /> • ♦ x <br /> • • ♦ • <br /> c. , <br /> • • <br /> i <br /> ATTACHMENTS CERTIFICATION STATEMENT <br /> ),the un I nerd_ccer Efy hat thi re t is complete and accurate to the best of my knowledge and belief. <br /> ' _ Geologic Log WJL n$ �!%oratorles, Inc <br /> Well Construction Diagram NAME Ep g�ry� <br /> P5 / FIRM OR V���nQTIO9tre�eED DfiRfNTt:D) Fresno CA 93721 <br /> _ Geophysical Log(s) ff.. �. 1 <br /> Soil/Water Chemical Analyses <br /> ADDRESS- CITY STATE /� ZIP <br /> — Other r r' '.r .. o 506159 <br /> ATTACH ADDITIONAL INFORMATION. IF IT EXISTS. Signed <br /> WELL DRILLER/AUTHORIZED REPRESENTATIVE DATE SIGNED C-51 LICENSE NUMBER <br /> DWR 188 SEV.7-90 IF ADDITIONAL SPACE IS NEEDED, USE NEXT CONSECUTIVELY NUMBERED FORM <br />