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JELL DATA SHEET (Panp 1 of <br />Complete as much information as possible. Leave blank if information is not available, use N.A. if not applicable. <br />Indicates items required for Source Water Assessment <br />" Indicates additional items required for assessments and Ground Water Rule <br />(separate multiple entries in <br />field with semi -colon) <br />Actual, Estimated <br />or Default? <br />DATA SHEET GENERAL INFORMATION <br />System Name <br />French Camp Golf Course from DHS database <br />System Number <br />3901377 <br />from DNS database <br />Source of Information (well log, DHS/County files, system, etc) <br />SJ County files <br />Organization Collecting Information (DHS, County, System, other) <br />5/22/2002 <br />Date Information Collected/Updated <br />WELL IDENTIFICATION <br />" Well Number or Name <br />wellhead <br />from DHS database <br />• DHS Source Identification Number (FRDS ID No.) <br />3901377-001 <br />DWR Well Log on File? ("YES" or "NO") <br />yes <br />State Well Number (from DWR) <br />Well Status (Active, Standby, Inactive) <br />active <br />from DHS database <br />WELL LOCATION <br />Latitude <br />37.86524194 <br />from DHS database <br />Longitude <br />121.2225145 <br />from DHS database <br />Ground Surface Elevation (ft above Mean Sea Level) <br />Street Address <br />3919 E French Camp Rd <br />Nearest Cross Street <br />Hwy 99 <br />City <br />French Camp <br />County <br />San Joaquin County <br />Neighborhood/Surrounding Area (see Note 1) <br />Site plan on file? ("YES" or "NO") <br />yes <br />DWR Ground Water Basin <br />to come from DWR <br />DWR Ground Water Sub -basin <br />Ito come from DWR <br />SANITARY CONDITIONS <br />" Distance to closest Sewer Line, Sewage Disposal, Septic Tank (ft) <br />1200 <br />Distance to Active Wells (ft) <br />1400 <br />Distance to Abandoned Wells (ft) <br />Distance to Surface Water (ft) <br />'* Size of controlled area around well (square feet) <br />• Type of access control to well site (fencing, building, etc) <br />• Surface Seal? (Concrete slab)("YES", "NO" or "UNKNOWN") <br />yes <br />• Dimensions of concrete slab: Length(ft)/ Width(ft)/ Thick(in) <br />• Within 100 year flood plain? ("YES", "NO" or "UNKNOWN") <br />yes <br />• Drainage away from well? ("YES" or "NO") <br />ENCLOSURE/HOUSING <br />Enclosure Type (building, vault, none, etc.) <br />none <br />Floor material <br />Located in Pit? ("YES" or "NO") <br />no <br />Pit depth (feet) (if applicable) <br />WELL CONSTRUCTION <br />Date drilled <br />11/2/1994 <br />Drilling Method <br />reverse rotary <br />Depth of Bore Hole (feet below ground surface) <br />340 <br />Casing Beginning Depth/Ending Depth(ft below surface); <br />2nd Casing Beginning Depth/Ending Depth; 3rd Casing, etc. <br />0/205 <br />Casing Diameter (inches); 2nd Casing Diameter; 3rd Casing, etc. <br />12 <br />Casing Material; 2nd Casing Material; 3rd Casing, etc. <br />steel <br />French Camp Golf/Well Data Sheet 5/22/2002 <br />