FIELD DOCUMENTS_2008-2015 - Laserfiche WebLink

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The free Adobe Reader may be used to view and complete this form. However,software must be purchased to complete,save,and reuse a saved form. • File 6riginal with DWR • State of California M DWR Use Onl –Do Not Fill In Page of Well Completion Report Refer to Instruction Pamphlet Owners Well Number MW-128B No ep167742 State WeII Number/Site Numher Date Work Began 11/12/2012 Date Work Ended 11/13/2012 w Latitude Lp Loral Permit Agency San Joaquin CoLnty Environmental Health Permit Number 66015 Permit Date 10/29/12 gPNrtRs/Omer Geologic Lo2 Well Owner Orientation O Vertical O Horizontal OAngle Speciry Name Arcadis Drilling Method Sonic Dolling Fluid Mailing Address 2000 Powell St 7th Floor Depth from Surface Description Fast m Fast Describe material,grain sae,color,etc City Emeryville State CA �i 94608 0 10VFine s Well Location 10 12ed sandy clays with gravels Address 333 W Beniamin Holt 12 30fine sand City StocktonCounty San Joaouin 30 3838 41 Latitude N LongitudeDMieDep. Mn. Sec46 Datum Dedmal Lat. Decimal Long.46 47 APN Book Page Parcel 47 52 Sand Towrishi Rance Section 52 55 Thick sandy clay Location Sketch Activit 55 61 Hard silty clay/clayey silts Skemhmusltedramb hand afierform is anted. New Well 61 65 Clayey sand/sandy clay North O Modification/Repair 65 73 Silty clay with some fine sand O Deepen O Other- 73 her73 75 Clayey sand/sandy clay O Destroy 75 78 Clayey sand 13p1,ep"Wu° a•am•t•'•'• uMx'GEOLOGIC LGG' 78 80 Very hard sandy clay/clayey sand Planned Uses 80 88 Sandy silts O Water Supply 88 89 Poorly graded sand ❑Domestic ❑Public 89 92 Sandy silts El Irrigation El Industrial w 92 97 Silty with Clay O Cathodic Protection 97 99 Sil clay/clayey silts O Dewatering 99 104 Silty Sands O Heat Exchange O Injection 104 107 Sandy silts O Monitoring 107 108 Silts with some sand O Remediation 108 110 Silty Sand O Sparging 110 115 Sandy silts and clays south O Test Well 115 118 Thick and hard Silty Clay nmae.leordawdhedmanmofwll r— ao. odn.bauideama>,reaa. O Vapor Extraction ada.m,puse „ e 118 119 Sand O Other 119 122 Clayey silts/silty Clay Water Level and Yield of Completed WeII 122 124 Sand silt Depth to first water (Feet below surface) 124 132 Clayey silts and silty clays Depth to Static Water Level (Feet) Date Measured Total Depth of Boring .132 Feet Estimated Yield (GPM) Test Type Total Depth of Completed Well 104 Feet Test Length (Hours) Total Drawdown (Feet) 'May not be re resentative of a well's Ion2 term 'eld. Casings Annular Material Surf Type O from Borehole Te Material Wall Outside Screen Slot Size Depth from Surface Diameter Feet to Feet Thickness Diameter Type If Any Surface Fill Description Inches Inches Inches Inches Feet to Feet 0 89 167/8 Blank PVC Sch 80 2 0 76 Neat Cement 89 104 6 7/8 Screen PVC Sch 80 2 Slot 0.010 76 79 sentonite Pellets 79 132 Sand 2/12 Attachments Certification Statement ❑Geologic Log I,the undersigned,certify that this report is complete and accurate to the best of my knowledge and belief ❑Well Construction Diagram Name Cascade DrillinD L P ❑Geophysical Log(s) Person,Firm or Carporakan 3632 Omec Circle Rancho Cordova CA 95742 ❑ Soil/Water Chemical Analyses res city state Lp ❑+ Other Site Mao Signed /��}y�i /1r��TOJ-� 01/08/13 938110 Attach atlditional Inmrma6Gn 'dit exists. —G-57 Licensed Water Well Contractor Date Signed C-57 License Number DWR 188 REV.1/2006 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECIrIVELY NUMBERED FORM