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SITE INFORMATION AND CORRESPONDENCE_2004-2019
EnvironmentalHealth
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SITE INFORMATION AND CORRESPONDENCE_2004-2019
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Last modified
8/13/2020 2:16:35 PM
Creation date
8/13/2020 12:19:52 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
SITE INFORMATION AND CORRESPONDENCE
FileName_PostFix
2004-2019
RECORD_ID
PR0505553
PE
2960
FACILITY_ID
FA0006856
FACILITY_NAME
FRANKS FOOD MART
STREET_NUMBER
2072
Direction
W
STREET_NAME
YOSEMITE
STREET_TYPE
AVE
City
MANTECA
Zip
94336
APN
22202001
CURRENT_STATUS
01
SITE_LOCATION
2072 W YOSEMITE AVE
P_LOCATION
04
P_DISTRICT
005
QC Status
Approved
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EHD - Public
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4 I , <br /> 'The free Adobe Reader may be used to view and complete thi However,software must be purchased to complete,save,a use 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 <br /> State Well Number/Site Number <br /> Owner's Well Number MW-25 No. e0265051 <br /> NI I I I I T71W] <br /> Date Work Began 03/03/2015 Date Work Ended 3/3/2015 Latitude Longitude <br /> Local Permit Agency San Juaguin Cnty Environmental Health Department <br /> Permit Number 200-140-08 Permit Date 7/25/15 APN/TRS/Other <br /> Geologic Log <br /> " Well Owner <br /> Orientation O Vertical O Horizontal OAngle Specify Name bo—t✓t�t-( 6 US L" <br /> Drilling Method Auger Drilling Fluid g �/ A ) � � <br /> Mailing Address �i�: �c�c�. <br /> Depth from Surface Description Manteca Ca 95336 <br /> Feet to Feet Describe material, rain size,color,etc Cit State dip <br /> 0 20 Brown Fine silty sands Well Location <br /> 20 55 Well Graded sands fine/course Rounded pea graU Address <br /> City Manteca County <br /> Latitude N Longitude _yv <br /> Dec. Min. Sec. Dec. Min. 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.) G) 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 /> w ❑Irrigation ❑Industrial <br /> O Cathodic Protection <br /> O Dewatering <br /> O Heat Exchange <br /> O Injection <br /> G Monitoring <br /> O Remediation <br /> O Sparging <br /> South O Test Well <br /> Illustrate or describe distance of well from roads,buildings,fences, O Vapor Extraction <br /> rivers,etc,and attach a map.Use additional paper d necessary. O Other <br /> Please be accurate and complete. <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 Well 55 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 /> 55 45 18 Screen 1PVC SCH40 2" Slot 10.020 55 143 Sand #3 <br /> 45 0 18 Blank JPVC SCH 45 2" 43 41 Bentonite Chips <br /> 41 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 /> ❑ Geophysical Log(s) 3000 Duluth West Sacramento CA <br /> ❑ Soil/Water Chemical Analyses A ci state zip <br /> EDother Site map Signed Y -r 938110 <br /> Attach additional information.if it exists. C-57 Licensed Water 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 />
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