Laserfiche WebLink
'The free Adobe Reader maybe used to view and completeWrm. However,software must be pc'chased to complete,savie reuse a saved form. <br /> File Original with DWI Slate of California DWR Use Only—Do Not FIII In <br /> Well Completion Report 1-j-1-T-1 -7-T-77-1-111� <br /> Page 4 of i6 Refer to Instruction Pamphlet <br /> Owner's Well Number VW4 No. e0150667 State Well Number/Site Number <br /> Date Work Began 03/26/2012 Date Work Ended 4/3/2012 -i.- Latitude ] _LJ. Longitude <br /> w <br /> Local Permit Agency San Joaquin County Environmental Health Department F-1-7-77 I i i i , I <br /> Permit Number NA Permit Date 3/5/12 APN/TRS/Other <br /> Geologic Log Well Owner <br /> Orientation OVertical O Horizontal OAngle Specify Name Pensco Trust Co Cust Etal <br /> Drilling Method Hollow Stem Auger Drilling Fluid Bentonite mud <br /> Depth from Surface Description ME fling Address PO Box 144 <br /> Feet to Feet Describe matenal,grain size,color,etc Cit., Linden State CA --zip 95326 <br /> 20 0 Drill,Sample and Install VW to 20'using Well Location <br /> well materials listed below. Address 1601 Turnpike Road <br /> City Stockton County San Joaquin <br /> Latitude N Longitude __ w <br /> Deq Min. Sec. Dec. Min. Sec <br /> Datum Decimal Lat. Decimal Lang. <br /> AF'N Book 165 Page 040 Parcel 13 <br /> Tc wnshi —Range Section <br /> Location Sketch Activity <br /> $ketch must be drawn by harm after lone Is rimed. G) New Well <br /> NorthO Modification/Repair <br /> O Deepen <br /> O Other <br /> O Destroy <br /> oeeoibe proce"'M end maleula <br /> unee,'GEOLOGIC LOG' <br /> Planned Uses <br /> C� O Water Supply <br /> ❑Domestic ❑Public <br /> jil —�` A ❑Irrigation []Industrial <br /> W <br /> O Cathodic Protection <br /> W(A O Dewatering <br /> O Heat Exchange <br /> O injection <br /> O Monitoring <br /> O Remediation <br /> O Sparging <br /> South O rest Well <br /> IUW vete <br /> &-b.diaenceotwell nom reeee.b0iinge.Imcee. O' Vapor Extraction <br /> mc.aodm,im.mep.u.e eedivonal aaoe�uneu.ea�y OOther <br /> Pi��ne bee uni.ane mm Ie1e. <br /> 'ater Level and Yield of Completed Well <br /> Depth to first water (Feet below surface) <br /> Cspth to Static <br /> Vater Level (Feet) Date Measured <br /> Total Depth of Boring 20 Feet Estimated Yield• (GPM) Test Type <br /> Tost Length (Hours) Total Drawdown_(Feet)Total Depth of Completed Well 20 Feet *1:4ay not be re resentative of a well's lonji term xield. <br /> Casings Annular Material <br /> Depth from Borehole Wall Outside Scven Slot Size Depth from <br /> Surface Diameter Type Material Thickness Diameter Tvpe if Any Surface Fill Description <br /> Feel to Feet Inches inches Inches Inches Feet to Feet <br /> 20 5 8 1 Screen PVC Soh.40 4 Milled Slots Q,Q2Q 20 3 Filter Pack #3 <br /> 5 1 8 Blank PVC Sch.40 4 3 1 Bentonite Chips <br /> 1 0 Cement Portland type 1/11 <br /> Attachments Certification Statement <br /> ❑ Geologic Log I,the undersiyretl,certify that thic report Is complete and accurate to the best of my knowledge and belief <br /> El Well Construction Diagram Name All Well Abandonment <br /> ❑ Geophysical LO 5 Parson,Firm or Corroraaon <br /> 9245 Beatt <br /> Drive Suite A �. ,.4mramento CA 95826 <br /> 1:1Soil/Water Chemical Analyses Addrea Cny state zip <br /> O Other Site Map Signed ` "'may 4/25/2012 848359 <br /> Attach additional Information if it exists. - 7Lic ran VPxrII r-niaclor Date Started C-57 License Number <br /> Own 188 REV.Ili IF ADDITIONAL SPACE IS NEEDED,USE I•EXT CONSECUTIVELY NUMBERED FORM <br />