Laserfiche WebLink
'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. <br /> • File Original with DWR • <br /> State of California DWR Use on –Do Not Fill In <br /> Page of Well Completion Report <br /> Owners Well Number MW-127A Refer b lnsbucbbn Pamphlet <br /> No. 430167743 State Well Number <br /> Date Work Began 11/09/2012 Date Work Ended 11/9/2012 N w <br /> Local Permit Agency San J08OUln CoLnty Environment^I Health Latitude LoL d� <br /> Permit Number 66015 Permit Date 10/29/12 <br /> APWTRS/Other <br /> Geologic Lo <br /> Ostentation O Vertical O HorizontalWell Owner <br /> Drilling Method Sonic OAngle Specify Name Arcadis <br /> Dnlling Fluid <br /> Depth from Surface Description Mailing Address 2000 Powell St 7th Floor <br /> Feet to Feet Describe material, rains¢, color,etc City Emerwille <br /> 0 10 Sand silts - state CA 7; 94608 <br /> 10 12 Fine grained sandy clays with gravelsWell Location <br /> 12 30 Silts with fine sand Address 333 W Benjamin Holt <br /> 30 38 Sand City Stockton County San Joaquin <br /> 38 44 Silts Latitude N Longitude <br /> Deo. Min. Sec. Deo. Min. Sec. W <br /> 52 56 S <br /> 44 52 Sand Datum Decimal Lat. <br /> Decimal Lon <br /> and Clay APN Book Page Parcel 9 <br /> 56 57 Sil clay Township Ran e <br /> Section <br /> Location Sketch Activit <br /> (Sketch must be prawn b hand after form is rated <br /> North O' New Well <br /> O Modification/Repair <br /> O Deepen <br /> O Other <br /> O Destroy <br /> 0—da nm.me,m.m m.i.dala <br /> uMa'GEOLOGIC LOG' <br /> Planned Uses <br /> O Water Supply <br /> ❑Domestic ❑Public <br /> w ❑Irrigation ❑Industrial <br /> O Cathodic Protection <br /> O Dewatering <br /> O Heat Exchange <br /> O Injection <br /> O Monitoring <br /> O Remediation <br /> O Sparging <br /> South O Test Well <br /> Invuar.we.au;n.dm.....rwmt rmm mem.balunq.sea— O Vapor Extraction <br /> MAIMS.ecand aaach a map.ua.aane <br /> ddamal ca ,endo",. O Other <br /> vk.,.be.ccumr..m cwn Lt.. <br /> a[er Level and Yield of Completed Well <br /> Depth to first water <br /> Depth to Static ��—(Feet below surface) <br /> Total Depth of Boring 57Water Level (Feet) Date Measured <br /> Feet Estimated Yield• (GPM) Test Type <br /> Total Depth Of Completed Well 55 Feet Test Length (Hours) Total Drawdown (Feet) <br /> Depth from <br /> 'Ma not be re resentalive of a well's Ion lens ield. <br /> Borehole <br /> Casin s Annular Material <br /> Surface Diameter Type Material wall Outside Screen Slot Size Depth from <br /> Feet to Feet Inches Thickness Diameter Type If Any Surface Fill <br /> Inches Inches Inches Feet to Feet Description <br /> 0 45 6 7/8 Blank PVC SCh 80 2 <br /> 45 55 6 7/8 Screen PVC 0 41 Neat Cement <br /> Sch 80 2 SIGs 0.010 41 43 Bentonite Pellets <br /> 43 57 Sand 2/12 <br /> Attachments Certification Statement <br /> LJ 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 Cascade Drillino LY. <br /> ❑ Geophysical Log(s) 3632 Omec Circle c p u <br /> ❑Soil/Water Chemical Analyses Rancho Cordova CA 95742 <br /> A d s <br /> ❑� Other.Site Mao Signed zp <br /> Attach additional inronnation.Hit exists. �' A or C'ty 01/08/13 936110 <br /> C-57 Licensed water well c actor Date Si ned C-57 License Number <br /> DWR 186 REV.12006 IF ADDmONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />