Laserfiche WebLink
. . <br /> The free Adobe Reader may be used to view and complete thi: However,software must be purchased to complete,save,a se a saved form. <br /> File Original with DWR State of California DWR Use Only-Do Not Fill In <br /> Well Completion Report <br /> Page of Refer to Instruction Pamphlet State Well Number/Site Number <br /> Owner's Well Number MW-27 No. e0265049 I INI I 1 1 1 1w <br /> Date Work Began 03/03/2015 Date Work Ended 3/3/2015 Latitude Longitude <br /> Local Permit Agency San Juaauin Cnty Environmental Health Department <br /> Permit Number 200-140-08Permit Date 7/25/15 APN/TRS/Other <br /> Geologic Log + WPII Owner <br /> Orientation O Vertical O Horizontal OAngle Specify Name <br /> Drilling Method Auger Drilling Fluid <br /> Mailing Address <br /> Depth from Surface Description <br /> Feet to Feet Describe material,grain size,color,etc City Manteca State­Ca--Zip 9 336 <br /> 0 15 Brown Fine silty sands _ ..,,�„ ...,, ,,...,.,...,:..........._._,..._._...."'Well Location.__..._ .__.._........._.. .... ....................._..... <br /> Address G !✓= A.- u <br /> City Manteca County <br /> Latitude N Longitude _yv <br /> Deq. Min. Sec. Deq. --ain Sec. <br /> Datum Dec.Lat. Dec.Long. <br /> APN Book Page Parcel <br /> Township -Range Section <br /> Location Sketch Activit <br /> Sketch must be drawn by hand after form isprinted.) Qi New Well <br /> North O Modification/Repair <br /> O Deepen <br /> O Other <br /> O Destroy <br /> Describe procedures and materials <br /> under'GEOLOGIC LOG' <br /> Planned Uses <br /> O Water Supply <br /> ❑Domestic ❑Public <br /> CZ Lu ❑Irrigation ❑Industrial <br /> O Cathodic Protection <br /> O Dewatering <br /> O Heat Exchange <br /> O Injection <br /> 0 Monitoring <br /> O Remediation <br /> O Sparging <br /> South O Test Well <br /> Illustrate or describe distance of well from roads,buildings,fences, O v IJUi EXtractlon <br /> rivers,etc.and attach a map.Use additional paper if necessary. O Other <br /> Please be accurate and com let,. <br /> Water Level and Yield of Completed Well <br /> Depth to first water (Feet below surface) <br /> Depth to Static <br /> Water Level (Feet) Date Measured <br /> Total Depth of Boring Feet Estimated Yield* (GPM) Test Type <br /> Total Depth of Completed Wel �S� Feet Test Length (Hours) Total Drawdown (Feet) <br /> *May not be representative of a well's long term yield. <br /> Casings Annular Material <br /> Depth from Borehole Type Material wall Outside Screen Slot Size Depth from <br /> Surface Diameter yp Thickness Diameter Type if Any Surface Fill Description <br /> Feet to Feet Inches Inches Inches Inches Feet to Feet <br /> 15 8 18 Screen JPVC SCH40 2" Slot 10.020 15 17 Sand #3 <br /> 8 p 18 Blank PVC SCH 4h 2" 7 6 Bentonite Chips <br /> 6 0 Cement Portland <br /> Attachments Certification Statement <br /> ❑ Geologic Log I,the undersigned,certify that this report is complete and accurate to the best of my knowledge and belief <br /> ❑ Well Construction Diagram Name Cascad Drilling L.P. <br /> Person,Firm or Corporation <br /> ElGeophysical Log(s) 3000 Duluth West Sacramento CA <br /> ❑ Soil/Water Chemical Analysesd r Cit State zip <br /> ® Other S iy�C W��3 J� Signe ✓ tS 938110 <br /> Attach additional information,if it exists. G57 Llcense� ater ell Contractor Date Signed C-57 License Number <br /> DWR 188 REV.1/2006 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />