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®RIfxINA'�c STATE OF CALIFORNIA w LY — DON T <br /> File wiat�T DNR" WELL COMPLETION REPORT O t _�� i <br /> Page _OE , Refer to Instructlaa Pampblet STATE WELL NOISTATION NO. <br /> Owner's Well No. No. ��1`�`�� �° ��I I i_JH1 r ( i 'I i Q <br /> qW Date Work Began 10-14-92 ,Ended 10—21—91 +� ! LATITUDE LONGITUDE <br /> Local Permit Agency StOCktOn <br /> Permit No. 21 —2-927 Permit Date 10-21-91 MU st R <br /> --- GEOLOGIC LOG WELL OWNER <br /> ORIENTATION (✓) .Z_VERTICAL _HORIzONrAI —ANGLE _{SPECIFY) Naroe•`, Bob Hol l0 W dy <br /> DEMLTO MRST WATER (FL)BELOW SURFACE -Mailing'Address 16937 BaCOi1 Rd <br /> DEPTH FROM -• '' ` Mosclest0�`• Calif. 95315 <br /> SURFACE DESCRIPTION ';,•. " .'•' <br /> Ft. to Ft. Dueribe material,grain s color,ac. � qtV > `� T'_ � WELL•I:OCATION STATE ZIP <br /> 1 360 Sandstone. Acl&ess I2 '- Tulv.'-Rd- <br /> 360 1370 Clay. 95240 <br /> 370 0 Sandstone. \ County Abin <br /> 380 400 Clay/ �� r IPLN Book Page s�amel <br /> 400 ' 408 Black S.aikd\.Gravel:<�. i TQwm iP-Aj Range ection '�� � <br /> (' a `�� s '+ ' i `: I:aEi�ii, I NORTH Longitude I WEST <br /> I 1 s, -, •,• . DEG. MIN. SED. DEG. MIN. SEC. <br /> LOCATION SKETCH ACTIVITY <br /> % y , NORTH (r ).r <br /> ' Y <br /> MODIFICATION/REPAIR <br /> —oacPen <br /> t t —Other(Specify) <br /> DESTROY(Describe <br /> ProcedurestandMatsdals <br /> 'c• ' '• (- .^'• c underVEOLOG/CLOG'� <br /> 1 "r• '� t•-� PLANNED USE(S)- <br /> of <br /> 1 I iUj <br /> 'to W MONITORING <br /> �t.D'V'l r WATER SUPPLY <br /> t I <br /> ' ' � Domeatte <br /> l 0 �� <br /> Pnbllo <br /> Intgallon <br /> I 1 <br /> Industrial <br /> e Way <br /> TEST WELL" <br /> 1 tDiaz, <br /> _CATHODIC PROTEG <br /> t 1 SOUTH TION <br /> Illustrate or Deveribe Distance of Well from Landmarks _OTHER(Specify) <br /> such as Roads,Buildings,Fences,Riven,etc, <br /> PLEASE BE ACCURATE tr COMPLETE. <br /> 1 1 <br /> MET HOD Cabl)te Rig. FLUID <br /> WATER LEVEL & YIELD OF COMPLETED WELL <br /> 1 I DEPTH OF STATIC i <br /> WATER LEVEL 140 (Ft.)•&DATE MEASURED 10—2 1—Q1 <br /> 1 ESTIMATED YIELD' (GPM) &TEST TYPE <br /> TOTAL DEPTH OF BORING 408 (Feet) TEST LENGTH (Hrs.)TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL A.0.8 (Feet) "May not be reprerentative of a well'r long-term yield <br /> DEPTH CASING ., <br /> S) DEPTH ANNULAR MATERIA <br /> FROM SURFACE SORE- TYPE �, FROM SURFACE TYPE <br /> HOLE INTERNAL GAUGE SLOT SIZE <br /> ORA. ,c z MATERIAL/ CE- BEN- <br /> DIAMETER OR WALL !F ANY MENT TONITE FILL FILTER PACK <br /> Ft. to Ft. (inches) THICKNESS Orches) Ft, to Ft. (�) ✓) (�) (IYPEISIZE) <br /> N <br /> 1 i <br /> ` 1 i <br /> t 1 <br /> 1 r <br /> , 1 <br /> 'ATTACHMENTS (4) CERTIFICATION STATEMENT <br /> _ Geologic Log 1,the undersigned,certify that this report is egmplete and accurate to.ths best of my knowledge and belief. <br /> Well Construction Diagram NAME D r I l.l.In� <br /> I <br /> Geophysical Log(a) 11y CORPORATION) (TED OR PRINTED) <br /> Soul/WaterChen9cal Analyses P.0.Box 42 Galt Ca 95632 <br /> ADDRESS CITY STATE zip <br /> _. Other <br /> ATTAt;FI ADDITIONAL INFORMA770At IF IT EXISTS. $lg 4-9-92 299383 <br /> WELL ORgII 7FRREPRESENTATIVE DATE SIGNED C-57 LICENSE NUMBER <br /> DWR 188 REV.7-90 IF ADDITIONAL SPACE IS NEEDED, USE NEXT CONSECUTIVELY NUMBERED FORM <br />