Laserfiche WebLink
'The free Adobe Reader may be used to view and complus form, However,software must be purchased to complete,send reuse a saved form. <br /> File Original with DWR State of California DVVR Use Only—Do Not Fill In <br /> Page 10 of 12 Well Completion Report -- <br /> RBrerlo instruction Pampb,er _ State Well Number[Site Number <br /> Owner's Well Number ASW-2 No, e0163026 <br /> Date Work Began 10122/2012 Date Work Ended 1 12412 2 �-- —I— N � _L— ---�-- W <br /> Latitude Lon itude <br /> Local Permit Agency v' I lth D <br /> Permit Number NA Permit Date 1014112 APNITRS/Cther <br /> . Geologic Log Well Owner <br /> Orientation OVertical O Horizontal OAngle, Specify Name Tarditi Rentals PTP <br /> Drilling Method Hollow Stem Auger Drilling Fluid Elenicnite mud <br /> DOtti from Surface Description Mailing Address 11396 N Hwy 99 <br /> Feet to Feet Describe material, rain size,color,etc C:11y LodiState CA �i 95240 <br /> 100 0 Pressure Grout Well Location <br /> I <br /> Address 11396 N. Highway 99 <br /> C ty Lodi County San Joaquin <br /> Latitude N Longitude <br /> " Deq, Min. Sec. Deq. Min- Sec. <br /> G atum Decimal Lat. Decimal Long. <br /> Ai'N Book 059 — Page 26.0 Parcel 10 <br /> Township —,Range Section <br /> Location SketchActivi <br /> ...Sketch must be drawn'b hand after formas nrned. .., O New Well <br /> North > <br /> Q Modification/Repair <br /> O Deepen <br /> O Other <br /> Destroy <br /> Describe procedures and materials <br /> under'GEOLOGIC LOG- <br /> Planned Uses <br /> O Water Supply <br /> ❑Damest{c ❑Public <br /> W ❑Irrigation ❑Industrial <br /> 1 U�1 0 Cathodic Protection <br /> O Dewatering <br /> O Heat Exchange <br /> O Injection <br /> O Monitoring <br /> O Remediation <br /> O Sparging g <br /> South <br /> O Test Well <br /> y <br /> Illu:.rete or describe distance of well'from roads,buildings,Fences, O Vapor Extraction <br /> riven.etc.and attach a map. Use additional paper if necessary. O Other <br /> Pkv se he accurate and eon late. <br /> liter Level and Yield of Com leted Well tt <br /> Depth to first water (Feet below surface) r <br /> Dr:•pth to Static <br /> Water Level (Feet) hate Measured <br /> Total Depth of Boring 100 Feet Estimated Yield" (GPM) Test Type <br /> Total Depth of Completed Well 100 Feet Test Length (Hours) Total Drawdown (Feet) <br /> *Ma not be repre of a well's Ion term ield. <br /> 'Casings Annular Material <br /> Depth from Borehole Wall Outside Screen Slot Size Depth from <br /> Surface Diameter Type Material Thickness Diameter Type if Any Surface Fill Description <br /> Feet to Feet Inches Inches Inches Inches Feet to Feet <br /> Attachments Certification Statement <br /> ❑ Geologic Log rNLame <br /> dersigned,certify that this report is complete and accurate to the best of my knowledge and belief <br /> ©Well Construction Diagram All Well Abandonment <br /> Geophysical Logs) Person,.FirmorCorporalicn <br /> Beatt Dite A Sacramento CA 95826 <br /> SoillWater Ghemical Analyses Aadws - city Statezip <br /> Other Site Ma 10125!2012 848359 <br /> .Attach additional information if it exists. �CS7 Licensed Water Well ontLicensed Water Well ractor Date Signed C-57 License Number <br /> DWR 188 REV.1/20DB IF ADDITIONAL SPACE IS NEEDED,USE NE:�T CONSECUTIVELY NUMBERED FORM <br />