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f <br /> ORIGINAL . OVT (c3 i TYlal-t STATE OF CALIFORNIA s a F I L <br /> File with DWR-n IS 904- I✓•rt h WELL COMPLETION REPORT <br /> 1 1 -Q q4) Refer to lnrtruetion Pamphlet STA WELL No.18TATi N NO, <br /> Page_. _of ❑ <br /> Owner's Well No. �o, 5 4 8 9 6 Q <br /> Date Work Began 2X-8-95 Ended 27�-10-95 LATITUDE LONGITUDE <br /> Local Permit Agency J uiri C UIIt P rOTHEi <br /> Permit No. 0 0 5 0 0 6 Permit Date 12-21 -94 <br /> GEOLOGIC CAGWELL OWNER <br /> X Mr'. 6harlie Bush_ <br /> DEPTH TO FIRST WATER A 0 (Ft-)BELOW SURFACE ,, 14lai1ing Address- 4,624, Wal l a's ey Way <br /> =DEPTH FROM �` i Sa�:�.di?L.1 CA 95368 5 <br /> SURFACE DESCRIPTION <br /> Ft. to Ft. Describe material grain size color,ere.. r clTv �• �- _ WELL LOCATION STATE ZIP <br /> 0'. 5 topsoil address' 01 Lane 1A ixG <br /> 5' 20 ' sand City. Ri •(fin'. <br /> 20 40 ' clay :.County '.San'.Joa uin <br /> 40; 54 coarse sand y` APN Gook Page arcei <br /> o<,. > <br /> 54' 77 Gla ►Y <br /> TonshiP flange Section <br /> 77' 90 sand `,' ' �L`' _ Latitude' ND Longitude WEST <br /> - •� - DEG. MrN. SEC. DEG. MIN. SEC. <br /> 0. 9S ' clay LOCATION SKETCH ACTIVITY {�) <br /> 98' 105 '•:;and' `' NORTH NEW WELL ' <br /> 1 05'. 1 1 7 i,-&lav MODIFICATIONIREPAIR <br /> 117; 120 ; sand'.-, <br /> and z ' I r1Td/►�1} .� Deepen <br /> 120'- 130 cls : , i _other(Specify) <br /> 130 135 •i_ band <br /> 135' 155 ' els ^DESTROY(Descrme f <br /> Procadurea snd',."rs <br /> 155 160-4' land, Under^GEDaOMLOW) <br /> 1601 180 cla:v TsPLANNED USES) <br /> �i <br /> 180' 192 ' sand w �D 9 MONITORING <br /> 192, ; clay al WATER SUPPLY <br /> I � <br /> � � � Damesllo <br /> e <br /> A 1r Public 1 <br /> W¢I� Irrigation <br /> i Why Induelrlal <br /> CATHODIC PROTEC- <br /> TION <br /> ' llluatrate or Describe Dfitance of Well from Landmarly _ _OTHER(Specify) i <br /> such as!toads,Buddhrgs,Fences,Rera <br /> fo ,etc. <br /> PLEASE BE ACCURATE&COMPLETE <br /> MING <br /> ETHOD_ Rotary FLUID <br /> WATER LEVEL. & YIELD OF COMPLETED WELL <br /> t , DEPTH OF STAT)' <br /> WATER LEVEL 23 (FI.) S DATE MEASURED 2-10-95 <br /> r , <br /> ESTIMATED YIELD' (GPM) d TEST TYPE <br /> TOTAL DEPTH OF BORING 19 2 (Feet) TEST LENGTH (Mrs.) TOTAL DRAWDOWN (Ft.) } <br /> TOTAL DEPTH OF COMPLETED WELL—19 0 (Feet) 'May not be representative of a well's long-rer)n yield. s <br /> DEPTH CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE BORE TYPE ! FROM SURFACE TYPE <br /> HOLE — INTERNAL GAUGE SLOT SIZE <br /> DIA d MATERIAL/ CE- TIER <br /> Onches) GRADE D)AMETER OR WALL IF ANY MENT TOEE FILL. FILTER PACK <br /> Ft. to Ft. m paahes) THICKNESS (Inches) Ff, to Fi- {�) (f) {�) (TYPEISIZE) <br /> 0: 180 11 PVC 6 1 /8 .316 0115 x 1 8" qrav. <br /> 180. 190 11 x PVC 6 8 .316 .120 , <br /> r , <br /> I � <br /> � � 1 <br /> , t <br /> ATTACHMENTS (L) CERTIFICATION STATEMENT <br /> Geologic Lag I,the undersigned,certify that INS report Is comp late and accurate to the beat of my knowledge and belief. <br /> Well Construction Diagram NAME Martin Pump & Supply; Inc, i <br /> (PERSON,FIRM,OR COWMTTDN) (TYPED OR PRINTED) i <br /> i Geophysical Log(a) <br /> SonlWater Chemical Analyses 5 11eed Road Oakdale Cag95361 <br /> ADDRESS CITY STATE ZIP <br /> _ Other <br /> ATTACH ADDITIONAL fNFORMATraN.10 IT EXISTS. 8lgned2—2 8—9 5 360851 <br /> } <br /> ATELCORIILER AU BRED ES AT DATE SIGNED M7 LICENSE NUMBER <br /> IDWR 188 BEV.7-W IF ADDITIONAL SPA NEEDED, USE NEXT CONSECUTIVELY NUMBERED FORM <br /> i <br />