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QUADRUPLICATE STATE OF CALIFORNIA W R USE ONLY — D O NOT FILIN <br /> For Local Requirements 'WELL COMPLETION REPORT <br /> Page—of <br /> IP1101 Refer to Instruction Pamphlet STATE WELL NO.ISTATION NO. <br /> L� <br /> Owner's Well No. No. 488283 ❑ <br /> Date Work Began JAM Ended LATITUDE LONGITUDE <br /> Local Permit Agency San <br /> Permit No. 91-2644 <br /> Permit Date <br /> APNITR /OTH <br /> GEOLOGIC LOC }WELL OWNER <br /> ORIENTATION (_:L) VERTICAL v_y HORIZONTTAL� ANGLE _(SPECIFY) Name Franklin Cole <br /> DEPTH TO FI&;WATER�(Ft.) BELOW SURFACE Mailing Address P-Q+ BOX 1114 <br /> DEPTH FROM �� 95376 <br /> _ <br /> SURFACE DESCRIPTION CIT, Tracy- STATE ZIP <br /> Ft. to Ft. Describe material,grain size,color,etc. WELL L 0 C IO N <br /> U 4 top boll Address • L I n d' <br /> 4 13 Sand City racy <br /> Ay County an Joaquin <br /> Grave! APN Book Page Parcel <br /> 43 125 Ctay Township Range Section <br /> 125 132 Gravel or <br /> Latitude NORTH Longitude � � wesr <br /> 132 160 Clay DEG- MIN. SEC. DEG. MIN. SEC. <br /> LOCATION SKETCH ACTIVITY195 GrAvel (�) <br /> NORTH _ NEW WELL <br /> ' 2 25 Clay MODIFICATION/REPAIR <br /> 22S 235 GraVel Deepen <br /> 235 245 Clay Other(Specify) <br /> DESTROY(Describe <br /> Procedures and Materials <br /> Under"GEOLOGICLOG•) <br /> PLANNED USES) <br /> • � w a (✓) <br /> w MONITORING <br /> - WATER SUPJY <br /> Domestic <br /> Public <br /> Irrigation <br /> Industrial <br /> "TEST WELL" <br /> CATHODIC PROTEC- <br /> SOUTH TION <br /> Illustrate or Describe Distance of Well from Landmarks — OTHER(Specify) <br /> such as Roads,Buildings,Fences,Rivers,etc. <br /> PLEASE BE ACCURATE & COMPLETE. <br /> DRILLING Rotary FLUID Bentonite <br /> METHOD <br /> WATER LEVEL h YIELD OF COMPLETED WELL <br /> DEPTH OF STATIC <br /> WATER LEVEL (Ft.) & DATE MEASURED <br /> ESTIMATED YIELD' (GPM) & TEST TYPE <br /> TOTAL DEPTH OF BORING (FO TEST LENGTH (Hrs.) TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL 10 (Feet) 'May not he representative of a well's long-term yield. <br /> DEPTH CASINGS) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE BORE- FROM SURFACE TYPE <br /> TYPE <br /> HOLE —.11 <br /> INTERNAL GAUGE SLOT SIZE <br /> DIA. { c a MATERIAL/ DIAMETER OR WALL IF ANY H <br /> BEN FILTER PACK <br /> (Inches) a o ONITf FILL <br /> Ft. to FL m ti �� = GRADE (Inches) THICKNESS (Inches) Ft. to Ft. (TYPElSIZE) <br /> lbu 14 ga 0 100 1 Xi <br /> ibug—a]- Screer 100I zoo <br /> ATTACHMENTS (:) CERTIFICATION STATEMENT <br /> __._ Geologic Log I,the undersigned, <br /> .clerttifythat this report is compiete and <br /> +accurate to the best of my knowledge and belief. <br /> Well Construction Diagram NAME HLNNIHIGS 3ROS. DRILLI IC CO• i INC. <br /> (PERSON, FIRM, OR CORPORATION) (TYPED OR PRINTED) <br /> GeophysicalLog(s) 3525 PELANDALE AVE, MODESTO CA 35356 <br /> — Sail Water Chemical Analyses <br /> ADDRESS CITY oo STATE n 8 F ZIP •3 <br /> Other _ p��7lG <br /> ATTACH ADDITIONAL INFORMATION. IF IT EXISTS. SiDaed .. ��yyr�yy�� 29 <br /> WELL GRILLER/AUTHORIZED REPRESENTATIVE .., DATE SIGNED C-57 LICENSE NUMBER <br /> DWR ibN11RV.7-y0 IF ADDITIONAL SPACE IS NEEDED, USE NEXT CONSECUTIVELY NUMBERED FORM <br />