Laserfiche WebLink
'The free Adobe Reader may be used to view and complete thi! However,software must be purchased to complete,save,a ise 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-33 No. <br /> e0265045 I I FNJI I I I I I `N <br /> Date Work Began 03/31/2015 Date Work Ended 3/31/2015 Latitude Longitude l <br /> Local Permit Agency San Juaauin Cnty Environmental Health DeDartment I I I I I I I I I I <br /> Permit Number 198-160-22 Permit Date 7/25/15 APNfrRS/Other <br /> Geologic Log Well Owner <br /> Orientation O Vertical O Horizontal OAngle Specify Name A Rossi INC <br /> Drilling Method Auger Drilling Fluid <br /> Mailing Address 611 N. Main St. <br /> Depth from Surface Description Manteca Ca 7 95336 <br /> Feet to Feet Describe material, rain size,color,etc Cit State Ip <br /> 0 20 Brown Fine silty sands Well Location <br /> 20 49 well Graded Sands fine course gravel mix Address 495 Airport Way <br /> City Manteca County <br /> Latitude N Longitude W <br /> Dea. Min. Sec. Dea. 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 is printed, O. New Well <br /> North O Modification/Repair <br /> O Deepen <br /> O Other <br /> 0 Destroy <br /> Describe procedures and materials <br /> under'GEOLOGIC LOG' <br /> Planned Uses <br /> O Water Supply <br /> ❑Domestic ❑Public <br /> UJ ❑Irrigation ❑Industrial <br /> O Cathodic Protection <br /> O Dewatering <br /> O Heat Exchange <br /> O Injection <br /> O Monitoring <br /> O Remediation <br /> O Sparging <br /> South O Test Well <br /> Illustrate or describe durance of well frau roatls,buildings,fences, <br /> O Vapor Extraction <br /> rivers,etc.and attach a map Use additional paper if 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 49 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 T Material Wall Outside Screen Slot Size Depth from <br /> Surface Diameter Type Thickness Diameter Type if Any Surface Fill Description <br /> Feet to Feet Inches Inches Inches Inches Feet to Feet <br /> 49 39 18 screen PVC SIC 40 2" Slot 0.020 49 37 Sand #3 <br /> 39 0 8 Blank PVC SCH 421 2" 37 135 Bentonite Chips <br /> 35 0 Cement Portland <br /> E— —I I I I I --1-1 <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 /> ElGeophysical LO Person,Firm or Corporation <br /> g(S) 3000 Duluth West Sacramento CA <br /> ❑ Oter Soil/Water Chemical Analyses g� d _%$ , ci state zip <br /> ❑ Other Si ned L � � Zq 938110 <br /> Attach additional information if it exists. C-57 Lice sed Water Well Convactor Date Signed C-57 License Number <br /> DWR 188 REV.112006 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />