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bR1G1NfAL STATE OF CALWORNIA U E O Y -- Do N I <br /> File wltol DWR WELL COMPLETION REPORT <br /> ` Refer to Itrrtrucrron Pamphlet STATE EL NOtSTA 14D ❑ <br /> Page--1.,DE�_ N0 4683 �� <br /> Owner's Well No MW—2 R MW-13 <br /> • Date Werk Began. 5 196 - Ended 4.15/91 1 LATITUDE LONGITUDE <br /> cal Permit Agency S;'i27 ,Tnarn�1 n -rnuntw Publ i r Health GPS-tz1rP <br /> Permit NO _00$755 _ Permit Date <br /> 3/22/96 APN17RSOPMR <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION (✓) -Z—VERTICAL —HORIZONTAL —ANGLS _(SPECIFY) N,,n,,' Di.Mi Ond Lummox <br /> ALPFII TO FIRST WATFR�—(FL) DELOW SURFACE Marling Address 5 'West Fifth, Suite 4600 <br /> D PTHMOM DESCRIPTION �' 'Los An' les} I-' y`SURFACE CA 90013-1025 <br /> STATE ZIP <br /> Ft to FI Describe material,gram stn,color,etc ` CITY ' "k WELL-1,0 C A T I O N <br /> '> ' Ai4dress 151 S 1xt t eet <br /> ' city_ I `nteca_c <br /> ClDuntvq San Jai In Countv . <br /> APN flavk Hage © areal <br /> TgWnsfttp „ Rang Section <br /> �Latiftede ' r NORTH Longitude 1 1 WEST <br /> DEG MINSEC DEG MIN SED. <br /> 41 LOCATION SKETCII ACTIVITY (.!L) <br /> NORTH 2 NEW WELL <br /> MODIFICATIONOMPARI <br /> Oeepan <br /> j t . r r `E ( _Other(SpecNy) <br /> r t <br /> I SEE ATTACHED DESTROY(Deacrtba <br /> - Procedures andMalurtale <br /> L. Under CEOLOGICLOG) <br /> H PLANNED USES} <br /> 00 <br /> r <br /> Lu ,.^ MONITORING <br /> e i WATER SUPPLY <br /> r 1 Domeaft <br /> 1 t <br /> �^ <br /> Public <br /> t <br /> Irtlgatian <br /> r r <br /> , r InrSualr[al <br /> r <br /> TESTWELL- <br /> CATHODIC PROTEG <br /> r SOUTH TtON <br /> Illustrate ar DrscrMe Distance of Well from Landmarks OTHER(Speedy) <br /> such as Itoads Stafflings Felt= Rmcrs etc <br /> ' PLEASE BE ACCURATE lr CDtTIPLETF_ <br /> r I <br /> MDRILLING <br /> HOD_ H0l1.Uw Stem anger FLUID <br /> WATER LEVEL k YIELD OF COMPLETED WELT. <br /> DEPTH OF STATIC <br /> WATER LEVEL (Ft) & DATE MEASURED <br /> ' ESTIMATED YIELD` (GPM) R TEST TYPE <br /> TOTAL DEPTH OF BORING (Feet) TEST LENGTH (Hrs) TOTAL DRAWDOWN (Ft) <br /> TOTAI.DEPTH OF COMM rTCD WEI L (Feet) 'Alay not he representative of a wellt long tents yield <br /> DEPTH CASTNC(5) ANNULAR MATERIAL <br /> BORE DEPTH <br /> FROM SURFACE HOLE TYPE ✓ FROM SURFACE TYPE <br /> DIA w � - MATERIAL/ INTERNAL GAUGE SLOT SIZE CE- SEH <br /> {Inohoa) w �- d DIAMETER OR WALL IF ANY FILTER PACK <br /> rc oma. GRADE <br /> MEW TON{TE PILL (TYPEtSIZE) <br /> Ft to Ft �� (Inchos) THICKNESS (fiches) Ft to Ft <br /> ., <br /> 12.5"x PVC 411 SCH 40 0 6 X <br /> 10 30 Ix I I PVC SCH 40 6 8 x <br /> 8 30 X 2/12 sand <br /> r ' <br /> r <br /> r <br /> ATTACHMENTS (Z.) CERTIFICATION STATEMENT <br /> 1 the undersigned, certify That this report is complete and accurate to the best DI my knnwlec'go and belief <br /> Geologic Lag <br /> Well ConstructionDrngram NAmEr Spectrum EXploratlon, M'. JT.m Kh-enfelder _ !r.'') <br /> (PERSON FIR A DA CORPORA110N) (TYPED OR PRINTED) <br /> �_ Gaophy91aa1 Chemical <br /> 23 Drive, Stockton CA 95205 <br /> �C Sant Water Chem[eal Aaalysea <br /> -A CITY STATE ZIP <br /> Other Af <br /> ATTACH ADDITEONAI WFOAMA7ION 1F IT EXESTS SrQned 27� <br /> WECL t1EA AU HO D REPRES A O T Sl D C57 LICENSE NUMBER <br /> DWR 188ILEV 7-90 IF ADDITIONAL SPACE IS NEEDED, USE NE NSECUTIVELY NUMBERED FORM <br />