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(320 <br /> ORIGINAL STATE OF CAUFORNiA DEWATA�TIWEU <br /> D O File with DWR WELL COMPLETION REPORT ��Page_._Of Refer to Instruction PamphletNO.IS qT ON NO. <br /> Owner's Wel!No. No. 11��( �-- <br /> Date Work Began Nov. 15. 19 9 5, Ended 460981 LATITUDE �oxa�D'E'-�-t l--'' <br /> isLocal Permit Agency San Joaquin Co. Health Dept <br /> Permit No. 7817 Permit 6EULTREI/MER <br /> GEOLOGIC LOG ''` <br /> " WELL OWNER <br /> ORIENTATION (_} _X VERTICAL —HORIZONTAL ANGLE —(SPECIFY) Nage`.'NFO 01 a n,.S W gat e r S y s t ettl/M e 1 1 o r <br /> DEPTH TO <br /> DE FROM FIRST WATERT.3 5 (FL)BELOW SURFACE ,�: Mailing%'Add3e�s_21$0�.Wt �C'o�C Rd. <br /> C a <br /> SURFACE DESCRIPTION z' �'• ':StOC'k�`.On 9 5 215 <br /> .. �."� <br /> Ft. to Ft. Describe material gain size color.ete. -t` �� �Y. � 4 t STATE zi <br /> t WELL;Y;OCATION <br /> I eHa� •,: ,;y 1, tddYess• r r'-�1 �" R d <br /> -Pana n .� <br /> . � et r1AV ., .+ _ -,•. •. , ;Count _ S an�/•' p�Ll i n <br /> '` '' °'� ' i1PN Bootc7r�' "Pa e <br /> e ��.• ;i�11 ' } or g Parcel r r— <br /> ` ` 03 <br /> TQwnslli D�''� NangeC 9 j� Section L <br /> ana <br /> e z ' I atitTlde e e NORTH Longitude r wesr <br /> DEG. MIN. SEC. <br /> e , .3 .✓•�. + .� (t- t` DEG. MSN. $EC. <br /> R F; C1 �< <` ;�� , ,a ak % {;� LOCAT NOIR ETCH ACTIVITY (.!f.)-- <br /> ,, a e♦'• ♦ <. ;1 )L NEW WELL <br /> _ a 4 <br /> 7 r, <br /> e e ` 1 r MODIFICATION/REPAIR <br /> ° ° t _Deepen <br /> p rd ri Ih8 1; f{+ <br /> e �' ' ! _Other(Speci129 <br /> fy) <br /> 105 <br /> DESTROY(Describe <br /> PiocedureaandMaterlala <br /> Under"GEOLOGICLOG'9 <br /> y �' PLANNED USE(S)- <br /> Sh le <br /> 4 <br /> e , 'L -MO(NRORAJG <br /> I <br /> WATER SUPPLY <br /> � 1 <br /> 041 2 2 <br /> , X--- Dcmastic <br /> e Public <br /> ,® Irrigation <br /> Industrial <br /> 250 283,; Rha 1 <br /> e e F:ine Sind — "TEST WELL" <br /> SUTH _CATHODIC PROTEC• <br /> i i Illustrate or Describe Distance of Welf from Landmarks —OOTTHER(Spee(ly) <br /> Isuch as Roads,Buildings,Fencer,Rivers,etc.�k Sand <br /> PLEASE BE ACCURATE&COMPLETE. <br /> 35n! qhnlinDRILLING M i l d Rn <br /> ..3Ly FLUID tiliifiPr/$gntnn i te <br /> WATER LEVEL a YIELD OF COMPLETED WELL <br /> DEPTH OF STATIC <br /> r WATER LE 135 (Fl.) &DATE MEASURED N h V_ 1 , 19 9 5 <br /> ESTIMATED YIELD* (GPM) It TEST TYPE <br /> TOTAL DEPTH OF BORING 380 (Feet) TEST LENGTH (ars.)TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL �Q_(Feet) "May not be representative of a WC]Ps tong-term yield <br /> DEPTH CASING(S) ANNULAR MATERIAL <br /> FROM SURFACE BORE- DEPTH <br /> HOLE TYPE FROM SURFACE <br /> DIA. 4 NMRNAL GAUGE SLOT SIZE TYPE <br /> MATERIALt DIAMETER OR WALL IF ANY CE• RER- <br /> Ft, to Ft. (trachea) T11 �, ` GRADE MEM TDNRE FILL FILTER PACK <br /> � (inches) THICKNESS (Inches) Ft. to FL ✓ II (TYPE/SIZE) <br /> ' Pvr Fi" 0 110 <br /> 320 ' 360 12 X PVC 6" 460sch Screen 140 ° 360 X Sand Gravel <br /> , <br /> r <br /> e r - <br /> ATTACHMENTS (f) — CERTIFICATION STATEMENT <br /> .—.. Geologic Log b the undersigned,certify that this report is complete and accurate to the best of my knowledge and belief. <br /> _ Well Construction Diagram 1VAME H E N N I N GS BROS. DRILLING CO. , INC. 7.311 <br /> — Geophysical Log(a) (KIISON,I'MM.OR CORPORATION)(TYPED OR PRINTED) <br /> — SoD/WaleerChemicalAnslyssa 3525 PELANDALE AVE. MODESTO, CA 95356 <br /> — Other ADDRESS CRY STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION.1F rr Exrsrs srgnad 4L54NOV.30,1995 290813 <br /> GRILLER/ D REPRESErtiAilVE DATE SIGNED C S7 UCENSE NUMBER <br /> DWRINREV.T-®O tF ADDITIONAL SPACE IS NEEDED, USE NEXT CONSECUTIVELY NUMBERED FORM <br /> 03/V 0$"1F SIC 1 t1? <br />