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y ORIGINAL STATE OF CALIFORNIA <br /> File with DWR WELL COMPLETION REPORT <br /> tZ 1 Refer to Instruction Pampblet sTA WELL Noas N NO, i I <br /> Page_of ❑ ❑ <br /> [ Owner's Well No. <br /> 4 Date Work Began 04/29/96 Ended 05/04/96 0. 468064 LATITUDE LONGITUDE <br /> i Local Permit Agency <br /> Permit No. 8598 Permit Date APN' I <br /> OTHER <br /> GEOLOGIC LOG WELL OWNER F i <br /> XEd Keaster` <br /> ORIENTATION (�) VERTICAL HORIZONTAL ANGLE _ (SPECIFY) Name - <br /> DEPTH TO FIRST WATER IFQ 13ELOW SURFACE Mailing-Address 4460- Mair fargaa Dr . I <br /> DEPTH FROM Stockton• .r - CA 95'215 <br /> SURFACE DESCRIPTION _ "^ . <br /> Ft. to Ft. Dambe material,grain size,coloT,etc, CITY STATE ZIP <br /> • WELL LOCATION <br /> O :4 :Soil Address 3016 Munford Lane <br /> 4 14 Sandy Clay City 'Stockton <br /> 14 :18 :Sand .County San Joaquin <br /> 18 :55 :Clay <br /> APN BookiimRange <br /> `( age y/ arcel �? <br /> 55 :62 Sandy <br /> -Township Section62 '85 Clay ;ki <br /> Latitude ' ' NORTH Longitude t <br /> 85 :89 :Sand DEG: MIN- SEC. DEG. MIN. SEC. WEST <br /> LOCATION SKETCH ACTIVITY <br /> ` <br /> 89 :110 ,Clay - � '., NORTH X NEW WELL <br /> 110 1 116 =Coarse'-Sand, <br /> 116 :155 :Clay.; i t MODIFIGATION�REPAIR <br /> '� "- _Deepen <br /> 155 :170 :Coars'e':Sand•_ _Other(specify) <br /> f 170 :1.71 ...;Clay $ <br /> " 171 :1.73 iSand <br /> - - —DESTROY(Describe <br /> 173 :200. :Clay <br /> Procedures and Materiel: <br /> Under"GEOLOGICLOG' <br /> r PLANNED USE(S) <br /> m m <br /> lu <br /> _ 3: L MONITOMNG <br /> WATER SUPPLY <br /> X <br /> Domeelic <br /> i <br /> _ PuCrc, <br /> 1 irrigation <br /> Industrial <br /> "TEST WELL" <br /> _ CATHODIC PROTEC <br /> SOUTH TION i, <br /> Illusirate or Describe Distance of Well from Landmarks _ OTHER(Specify) <br /> such as Roads,Buildings.Fences,Rivers,etc. <br /> PLEASE BE ACCURATE & COMPLETE. <br /> DRILLING ROTARYWATER I <br /> METHOD FLi11D <br /> WATER LEVEL & YIELD OF COMPLETED WELL <br /> DEPTH OF STATICrro <br /> WATER LEVEL (Ft.) & DATE MEASURED <br /> ESTIMATED YIELD* (GPM) A TEST TYPE <br /> TOTAL DEPTH OF BORING 200 (Feet) TEST LENGTH (Hrs.) TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL 176 (Feet) I "May not be representative of a well's long-term yield. F <br /> DEPTH CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE BORE TYPE FROM SURFACE TYPE <br /> HOLE INTERNAL GAUGE SLOT SIZE <br /> DIA. ,e I E c a MATERIAL! CE- BEN- 'f <br /> DIAMETER OR WALL IF ANY FILTER PACK <br /> 1 o" a GRADE MENT TONiTE FILL <br /> T Ft. to FL (Inches) �_ (inches) THICKNESS (Inches) Ft. to Ft. (TYPElSIZE) <br /> 0 156 12 X PLASTIC <br /> ATTACHMENTS CERTIFICATION STATEMENT <br /> t <br /> ( <br /> Geokogkc Lop <br /> I,the undersigned,certify that this report is complete and accurate to the best of my knowledge and belief. <br /> _ � �-- <br /> i r �„ <br /> a Well Conskruction Diagram NAME " L <br /> {PERSON, t°IRM, RCD N) ( Y R k EG)- . <br /> GeophysicalLog(s) <br /> Soil/Water Chemical Analyzes I a Rd- Modesto- CA <br /> 57 <br /> ADDRESS cm STATE ZIP <br /> Other L ATTACH ADDITIONAL INFORMATION-,1F IT EX75T5- <br /> Signed r Q5/08/96 j <br /> LL RILLER AUTNG aED � A DATE SIGNED Z-57 LICENSE NUMBER <br /> DWB IRA REV 7-90 IF ADDITIONAL SPACE IS NEEDED, USE NEXT CONSECUTIVELY NUMBERED FORM S <br />