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ORIGINAL. STATE OF CALIFORNIA N Y <br /> File with DWA WELL COMPLETION REPORT NQi <br /> Page of Refer to fnttruction Pamphlet STATE WELL NO/STATION NO—4 - <br /> Owner's <br /> NOwner's Well No No 576585 � C} <br /> Date Work Began 9/30/96 Ended 9/30/96 LASE LONGITUDE <br /> Local Permit Aynncy San Joa n CO. D3.V. Of ErIV. Health <br /> Pcrmit No 1 Permit Date 30/96 <br /> GEOLOGIC LOC -WELL OWNER <br /> ORIENTATION (!) _X_VERTICAL ,...— HORIZONTAL ANGLE (SPECIFY) Flame Stockton B:Lshop Store House <br /> DEPTH TO FIRST WATER (FL) BELOW SURFACE Mailing Address 3112 Lo=s Rd. <br /> DEPTH FROM Stockton CA. 95205 <br /> ' SURFACE DESCRIPTION r <br /> Ft to Ft Describe rnmertal,gram size color,etc CITY STATE ZIP <br /> 4 Gla WELL LOCATION <br /> 0 i <br /> 4 � $ + Sand Address Same <br /> 8 17 Cla - City <br /> ' 17 19 Sand County San Jos rI <br /> APN Book Page Parcel <br /> 19 34 Cls Township Rang Section <br /> 34 38 SandDEG MIN o` <br /> 38 ; 60 ; ClayLatitude_ 1 SEC NORTH Longitude wesr <br /> DEG MIN SEC <br /> 60 69 Blue Clay-+, <br /> LOCATION SKETCH �^ ACTIVITY <br /> pp e `, �-NEW WELL <br /> 88 <br /> 69 Sand/ aVel,', t MODIFICA71ONtREPAtR <br /> ' 88 ; 96 Cla' F` ` <br /> 96 98,_' : Safes`xi ss o —Deepen <br /> 9$ 101 C1a _ d t�et7 r l�t� _ .Other(Specify) <br /> 101 ' '119 Coarse sand `..�, �I � ,►dlf —DESTROY <br /> EST RuOrea entl Materta)e <br /> ' 119 � 132 ClaywUnder GesandhCLOG <br /> 132 134 Coarse Sand r M PLANNED USE(S) <br /> 134 136 ' Clay <br /> LU MONITORING <br /> 136 ; 175 ; Coarse sandfdG• WATER SUPPLY <br /> 175 197 Shale/blue clayX—. Domestic <br /> 197 203 Coarse blue sand — Pubtla <br /> 203 ' 208 ; Shale/blue-clay _ lrr+pation <br /> 20$ 218 Shale <br /> _ Industrial <br /> 218 222 Blue sand C.CPO A4 t 5 J' TEST WELL <br /> 222 250 Blue Shale — CATHODIC PROTEC <br /> 250 253 Blue sand SOUTH TION <br /> Illustrate or Describe Distance of Well from Landmarks ___ OTHER(Spsclty) <br /> - such as Roads Btnldings Fences Ricers etc <br /> PLEASE BE ACCURATE & COMPLETE <br /> ' DRILLING <br /> METHOD Mildrotary`�`�s FLUID Wates <br /> WATER LEVEL h YIELD OF COMPLETED WELL <br /> DEPTH <br /> WATER OLEVEL TIC 74I <br /> (Pt) S DATE MEASURED --1 /2L-g6 <br /> ' ESTIMATED YIELD' (GPM) S TEST TYPE <br /> TOTAL DEPTH OF BORING 253 (Feet) TEST LENGTH (Hrs) TOTAL DRAWDOWN (Ft) <br /> TOTAL DEPTH OF COMPLETED WELL IgD (Feet) 'May not be representative of a well's long-term yield <br /> DEPTH CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE BORE HOLE - <br /> TYPE ✓ FROM SURFACE TYPE <br /> -- - —DIA--— W -� W - - INTERNAL — GAUGE --SLOT-SIZE- -- --- - <br /> ,c zo 4 -MATERIAL/ DIAMETER OR WALL IF ANY 7MCE BEP/ FILTER PACK <br /> ches) a GRADE T TONITE FILLFt !o Ft � (inches) THICKNESS (Inches) Ft to Ft ) (✓ ) (� ) (TYPEISIZE) <br /> 0 160 11 X I I PVC 6 160 0 + 100 x <br /> 1-0-L 1 ,tA 1tt tI " .062 100 180 6X12 sand- <br /> ' ' <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. CalWatex Drilling Co._, Inc. <br /> (PERSON FIRM OR CORPORAPON) (TYPED OR TRINTED) - <br /> GeophyscalLoq(s) 300 S. Kilroy Turlock, CA. 95380 <br /> .� Soil!Water Chemical Analyses <br /> Other ADORES CITY STATE ZIP <br /> .� �� <br /> ATTACH ADO1770NAL INFORMATION IF tT FJCISTS Signed _�, 2 <br /> . - /96 434218 - <br /> WELL DRILLER AtJIMFIZEO REPRESENTATIVE DATE SIGNED C57 LICENSE NUMBER <br /> DWR!Pi REV 7 90 IF ADDITIONAL SPACE IS NEEDED USE NEXT CONSECUTIVELY NUMBERED FORM <br />