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IN, <br /> C:..: <br /> ORIGINAL STATE OF CALIFORNIA E13 <br /> 0912 ONLY — DO No; FILLAR <br /> -• Fits,-Wlth DWR WELL COMPLETION REPORT a 7 7 <br /> Page 1 of Refer to Instruction Pampblrt STATE WELL NO lSTATI NO <br /> g <br /> Owner's Well No 1 No 532850 17 <br /> Date Work Began Ended LkTTTUDE LONGITaoe rL <br /> Local Permit Agenc,Y f I ..�. _.I ._I I I . I I I I I <br /> Permit No 19169 Permit Date APNITAStOTHER <br /> A <br /> GEOLOGIC LOG ,WELL OWNER <br /> ORIENTATION (: X) VERTICAL _HORIZONTAL ANGLE _ (SPECIFY) Name Martin -Pump--& -Supply , Inc <br /> DEPTH FROM <br /> DEPTH TO FIRST WATER (Ft) BELOW SLRFkCE Mailing Address 5 Reed Rd'. <br /> ' .,,,.....,,,,._._ <br /> SURFACE Dh5CRIPTION OakdaleCA 9536 <br /> Ft to Ft Descnbe material,grain size,color etc CITY T r WELL L(}C A T I O N STATE XIP <br /> O 3 :soil Address 2584 E. Mariposa <br /> ' 3 112 'Sandy Clay City Stockton <br /> 12 -: 18 ;Coarse Sand County San Joaquin <br /> 18 : 28 :Clay APN Book Page Parcel <br /> 28 : 34 Fine Sand 3brvnship Range Section <br /> 34 ' or <br /> 60 CIBy Latitude ! NORTH Longitude WE$ <br /> 60 :68 :Sand & Gravel DEG MIN SEC DEG MIN SEC <br /> 68 ins Clay _ LOCATION SKETCH -- ACTIVITY (z�)_ <br /> NORTH A NEW WELL <br /> 138 1173 'Coarse Sand 4 t <br /> 173 ; 185 ;Sandy ClMODlF1CAnONlREPAIR <br /> Ay <br /> Clay <br /> ea <br /> 185 : 200 :Blue Clay pen <br /> —DDee=(Specify) <br /> DESTROY(Describe <br /> I � Procedures and Materiel <br /> Under GEOLOGICLOG <br /> ' ! PLANNED USE(S) <br /> w w (r) <br /> T.., MONITORING <br /> WATER SUPPLY <br /> i I <br /> x Domestic <br /> r <br /> Pub4c <br /> Irrigation <br /> Industrial <br /> — TEST WELT <br /> CATHODIC PROTEC <br /> SOUTH TION <br /> Illustrate or Descnbe Distance of Well from Landrnarks — OTHER(Specify) <br /> such as Roads Buildfngs Fences Rruers etc <br /> ' PLEASE BE ACCURATE & COMPLETE <br /> MROD ROTARY FLUID WATER <br /> WATER LEVEL & YIELD OF COMPLETED WELL <br /> DEPTH OF STATI <br /> WATER LEVEL �4 (Ft) & DATE MEASURED <br /> ' ESTIMATED YIELD' (GPM) & TEST TYPE <br /> TOTAL DEPTH OF BORING 200 (Feet) TEST LENGTH (Hrs) TOTAL DRAWDOWN (Ft) <br /> tTOTAL DEPTH OF COMPLETED WELL 180 (Feet) *fMav not be reprerentapve of a well's long-term}Held <br /> DEPTH CASING(S) DEPTH ANNULAR MI TERIAL <br /> FROM SURFACE BORE - - - - — — -- <br /> HOLE TYPE — FROM SURFACE �pE <br /> ' DIA MATERIALt INTERNAL GAUGE SLOT SIZE CE <br /> BE <br /> z� DIAMETER OR WALL. IF ANY MINT TO'N FILL <br /> (inches) <br /> oc� d GRADE FILTER PACK <br /> Ft to Ft m cop J (Inches) THICKNESS (Inches) Ft to Ft N (TYPEISIZE) <br /> (--) (—) (—) <br /> 0 160 12 X W PLASTIC 5 150 0 60 x <br /> ' 160 180 % 045 50 180 X GRAVEL <br /> I <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 /> Well Construction Diagram NAME�EL.,1.JS _DRILLING. INC _ <br /> Geophysical Logs) <br /> (PERSDN FIRM OR CORPORATION) (TYPED OR PRINTED) <br /> — 81,111 Weter Chemical Analyaea <br /> ' Other ADDRESS CITY STATE ZIP <br /> ATTACH AD0177ONAL INFORMA7TON IF n EXISTS 11 SD RE ESENTATI <br /> Igned OQ/0 3/97 <br /> LekADTHI DATE SIGNED C 51 L! N UMBER <br /> DWRL88REV 700 IF A41711TIONAl CAA!'= M MC=r%un IICC AICVT <br />