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3a -�./•Q <br /> ORIGINAL STATE OF CALIFORNIA DWR USE O N Y — D ) T FILL 1 .-- <br /> File with DWR WELL COMPLETION REPORT <br /> Page_�,'Z of 2 Refer. to Instruction Pamphlet STAT WELL—ELL NODS AT=No. <br /> Owner's Well No. No. 416721 <br /> j 16 7 21 � DE] <br /> I <br /> Date Work Began ,Ended / / '-t LATITUDE LaraGtTuoE <br /> Local Permit Agency SAN JOAQUIN COUNTY PUB. HEALTH <br /> Permit No. 6341 Permit Date_ 06/14195 APNITRaLTHER <br /> GEOLOGIC LOG \" ` WELL OWNER <br /> ORIENTATION (4) —VERTICAL —HORIZONTAL mug _(specim Naroi,, `t'T E RES3'. <br /> DEPTH TO FIRST WATER (FL)BELOW SURFACE I Mailtlng-Add; % �ti�.''.B� 1270 <br /> DSM <br /> DESCRIPTION ,'� � L 0 D 1 -.0 A Ity `•ti CA 9524.1 <br /> Ft. t0 Ft. Describe materia ain size,colo,etF �, \` 'Om, ; ��'— STATE ZIP <br /> 291 319 SAND CEMENTED GRAVELI.,$A 1D9TO � �;P t HELL,I.,!I C TION <br /> 291 31 AND SANDY CLAY ti .L i �. /dr)ress�, , <br /> 297 .310 LENSES <br /> _,Count'y <br /> 31$ 335 BROWN GLAYi\A ,-:SANDSTaNE� �' \` APNrBook® ageIr- <br /> 33-T-331arca( a <br /> SAND i '• '_. 1 °.�E Towstslii t Range Section <br /> 33735Q FIRM •.BROWN CLAD( NA' N8k ) NORTH Longitudee WESTIiu <br /> 3– , 350 SAND DFG. MIN. SEC <br /> DEO. MIN. SEC. <br /> LOCATION SKETCH ✓ <br /> ACTIVITY (—)— <br /> e NORTH — NEW WELL <br /> MODIFICATION/REPAIR <br /> Deepen <br /> Other(Specify) <br /> •* ^ <br /> DESTROY(Describe <br /> ProceduresandMatertele <br /> Usder"GIrDLOG(CLOGi J <br /> t- PLANNED USE(S)- <br /> tu <br /> 4• e) <br /> e , :•• 3 —MONITORNG <br /> ' WATER SUPPLY <br /> e e <br /> e , <br /> — Domestic <br /> t e — Publia <br /> a kdgetion <br /> r e <br /> _ Industrial <br /> ' e SOUTH — CAM ODIC PROTECG <br /> ' Illustrate-or Describe Distance of Well from Landmarks ._.OTHER(Specify) <br /> , , such as Roads,Bnddiags,Fences,Rttrers,etc. <br /> , e <br /> PLEASE BE rtCCElRATE b COi12PLET� <br /> • , DRILLING <br /> e i METHOD FLUID <br /> r WATER LEVEL & YIELD OF COMPLETED WELL <br /> e DEPTH OF STATIC <br /> r WATER LEVEL , (Ft.) & DATE MEASURED <br /> ESTIMATED YIELD' (GPM) & TEST TYPE <br /> TOTAL DEPTH OF BORING (Feet) TEST LENGTH (Fre.)TOTAL DRAWDOWN (Ft.) <br /> ' TOTAL DEPTH OF COMPLETED WELL (Feet) e May not be represertudve of a well!r long-term yield. <br /> DEPTH CASING(S) DOTH ANNULAR MATERIAL <br /> FROM SURFACE HOLE firm. <br /> FROM SURFACE TYPE <br /> DIA MATERIAL( INTERNAL GAUGE SLOT SIZE CE• BEN- <br /> (Inches) GRADE DIAMETER .OR WALL IF ANY FILTER PACK <br /> FL to FL pnahes) THICKNESS (Inches) Ft. to- Ft. MENT TDNITE FR L(✓) (✓) (✓) (TYPE/SIZE} <br /> e , <br /> r t <br /> � e <br /> , <br /> , t <br /> r , <br /> e � <br /> eATTACHMENTS (✓) CERTIFICATION STATEMENT <br /> Geologic Log f,the undersigned,certify that this report Is Complete and accurate to the best of my knowledge and belief. <br /> Well Construction Diagram NAME lo <br /> RPOttATION ED OR PRINTED) /? <br /> GeophysicalLog(e) MgmxtY(CE D�I LERS, INC. <br /> ._ <br /> SON/Water ChemicalAnalysea <br /> Other Pss ®_ BOX 64.a LINDEN' CA, 95236 CITY STATE ZIP <br /> ATTACH AODMONAL WFORWTIO)V.!F 1T EXISTS. Signed WELL DRILLER/AUTHORUED REPRESENTATNE DATE SIGNED C-57 LICENSE NUMBER <br /> DWR Ise Rrv.7-90 IF ADDITIONAL SPACE IS NEEDED.-USE NEXT CONSECUTIVELY NUMBERED FORM <br />