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ORIGINAL STATE OF CALIFORNIA DWR USEONLY — DO NOT FILL IN <br /> File With DWR WELL COMPLETION REPORT ® 1 ti ® 1 E <br /> Page eo1'1 Refer to Instruction PwnpWet STATE WELL 140.1 STATION W. <br /> ` •Owner°s Well No. 95215 No•7367 1 6 1 I � _1 J❑L I <br /> Date Work Began 7/5/01 , Ended7/W1 LATITUDE LONGITUDE <br /> Local Permit Agency Public Health Services <br /> Permit No. 26479 Permit Date 6/12/01 APNITRSIOTHER <br /> GEOLOGIC LOG <br /> ORIENTATION(f) VERTICAL —HORIZONTAL —ANGLE —(SPECIFY) <br /> DRILLING <br /> DEPTH FROM <br /> METHOD ROTARY FLUID Mud <br /> SURFACE I DESCRIPTION <br /> Ft. to Ft. Describe material, grain, sat, color, etc. <br /> 0 5�Soil WELL LOCATIO <br /> Address 12240 ManDose <br /> 5 11 ;Clay -- City Stockton CA - <br /> 11 23'Sand CountySan Joaquin — <br /> 23 60,Clay _—__-- __-- APN Book-- .._—Page Parcel.--- <br /> 601 63 Sand Township—Range___ Section <br /> 631 1151 Clay --. - Latitude I - 1 - <br /> 1151 1201 Sand_ DEG. MIN. SEC. - iicia. IiIN.. SEC. <br /> 1_20; 145;Clay - - LOCATION SKETCH ACTIVITY C/) <br /> NORTH -1-0' NEW WELL <br /> 145' 152'Coarse Sand <br /> - 1521 200:Clay MoolFl PA <br /> DOMP- <br /> 200' 208'Sand —Off-(Saerk q <br /> 208, 2121 Clay — <br /> — DESTROY(DscMe <br /> 2121 214;Gravel sod Maw <br /> 214 —280-',Clay _ _ PLANNED USES(z) <br /> p N <br /> WATER SUPPLY <br /> - to --Z Domestic— Pry <br /> Q <br /> Irrigation — Industrial <br /> 1 u! <br /> —' <br /> MONITORING.-. <br /> I.----- TEST WELL <br /> ® ATHODIC PROTECTION—. <br /> HEAT EXCHANGE <br /> DIRECT PUSH <br /> ---- —r — -- -- -- — •• --. _�_.—__ INJECTION <br /> --- VAPOR EXTRACTION <br /> 1 <br /> _— SPARGINGSOUTH _ <br /> Imssum or U-,W eDhti— fmmPAwk BWA§nA REMEDIATION <br /> Foraa,It vas,etc. and voub a s m.useit OTHER(SPECIFY) <br /> seesmasry.PLEASE IIS ACCURATE & GUM! <br /> WATER LEVEL&YIELD OF COMPLETED WELL <br /> I <br /> 1 1 DEPTH TO FIRST WATER-. —_—(Ft.)BELOW SURFACE <br /> DEPTH OF STATJP� <br /> WATER LEVEL R4 (FL)&DATE MEASURED ..7/6101 <br /> TOTAL DEPTH OF BORiNO 230 (Fed) <br /> YIELD (GPM)&TEST TYPE — <br /> (Fed) TEST LENGTH. .......(Mrs.)TOTAL ORAVVDOWtd <br /> TOTAL DEPTH OF COMPLETED wELL220 (Feet) Ya not be re nntadve o a weld's l -term field <br /> DEPTH CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE ORLE" i TYPE ✓ FROM SURFACE TYPE <br /> -- DIA• x w I2' MATERIAL t INTERNAL GAUGE CE_ <br /> SLOT SIZE T <br /> Ft to R. ( ) iv a GRADE DETER OR WALL IF ANY BEN ( FILTER PACK <br /> m ti 1 Ca (hdaes) THICKNESS , (Irk) Ft to Ft <br /> PENT TON FILL (7WEM <br /> 0 200 11 0 103 <br /> 2001 220 ✓ .045 103 220 --71GRAVEL <br /> I I <br /> I ' <br /> ATTACHMI&NTS (i.) CERTIFICATION STATEMENT <br /> — Gedopc Lop L msWNIOWSON"OW#0 rspat b Wrd ecranaie re to ebest of my � <br /> and t» . <br /> — Well Cmshmdcn DwWwn NAME MASELLIS DRILLING,INC. <br /> — Geowlsical Lops) (PERSON,FIRM,OR ORPORATION)(TYPED OR PRINTED) <br /> SoWWeler deer ow Amit"Is 11 AbRd. Modesto CA 95357 <br /> Dow ADDRESS CITY STATE ZIP <br /> ATTACk ADMOrM INFORMA770N,1F JT E76ST3 Soned07/11/01 668622 <br /> WELL DRft.LERMffTfflWM DATESIGNED C-R LICENSE NUMBER <br /> DW'&189REV 11-97 If ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />