Laserfiche WebLink
`The free adobe Reader may be used to view and complete this form. However, software must be purchased to complete, save, and reuse a saved form. <br />File Original with DWR State of California <br />Well Completion Report <br />Page 1 of 8 Refer to fnstruclfon Pamphlet <br />Owner's Well Number WR0404 018M No. e072547 <br />Date Work Began 03/20/2008 Date Work Ended 3/21/2008 <br />Local Permit Agency San Joaquin County Environmental He Ith <br />..._.. �..., fn w^ 1 ...­ 119 S1nQ <br />DWR Use Only - Do Not Fill In _ <br />State Well Number/Site Number <br />_ Latitude Longitude <br />APNITRS/Other <br />Geologic Log Well Owner <br />orientation O Vertical O Horizontal OAngle specify Name Department of Water Resources <br />Drilling Method Drilling Fluid Mailing Address 3110 EI Camino Ave <br />Depth from Surface Description tv Sacramento State CA Zi 95821 <br />Feet to Feet Describe material, rain size, color, etc Ci <br />Well Location <br />Address Reclamation District 404 Levee Crest <br />City Stockton County San Joaquin <br />Latitude 37 55 36 N Longitude 121 19 !L --P <br />Deo. Min. Sec. Dea Min. Sec. <br />Datum NAD83 Decimal Lat. 37.9268 Decimal Long. 121.3249 <br />APN Book Page Parcel <br />See Attached Log <br />Township Range Section <br />Sketch must be drawn by hand afterform is printed. Oi New Well <br />North Q Modification/Repair <br />O Deepen <br />O Other -- <br />0 Destroy <br />Oescdbe procedwx and male iais <br />under'GEOLOGIC LOG' <br />Planned Uses <br />Q Water Supply <br />F]Domestic ❑Public <br />m w ❑Irrigation ❑industrial <br />Q Cathodic Protection <br />Q Dewatering <br />0 Heat Exchange <br />Q Injection <br />@ Monitoring <br />0 Remediation <br />0 Sparging <br />0 Test Well <br />South <br />0 Vapor Extraction <br />Illustrate a descnbe distance of weft from road-, t u idings, fences. O <br />rivers. etc. and attach a map. Use additional paper if necessary . Other <br />plaa,e be a,;curate and <br />-ter Level and Yield of Completed Well <br />Depth to first water 23 (Feet below surface) <br />Depth to Static <br />Water Level 23 (Feet) Date Measured 04/22/2008 <br />Estimated Yield ` (GPM) Test Type <br />39 Feet <br />Total Depth of Boring <br />Test Length (Hours) Total Drawdown (Feet) <br />Total Depth of Completed Well 37 Feet <br />-May not be re resentative of a well's long term yield. <br />Annular Material <br />Cas ln <br />Depth from Borehole Wall Outside <br />Type Material Thickness Diameter <br />Screen from <br />Type face Fill Description <br />Surface Diameter Ines Inches) <br />o Feet <br />Feet to Feet Winches 3Cement Concrete <br />227 <br />27 $ Fill pipe PVC Sch. 40 <br />2 Milled Slots 22 Bentonite Cement/Bentonite 625 <br />1he <br />37 8 Screen PVC Sch. 40 <br />Bentonite 1/4" Bentonite Pell39 <br />Filter Pack 8 mesh sand <br />Certification Statement <br />Attachments <br />I, the undersigned, certify that this report is complete and accurate to the best of my knowledge and belief <br />0 Geologic Log <br />Name Gr Drillin 8t Testin Inc. <br />O Well Construction Diagram Person, Firm or Corporation <br />Martinez CA 94553 <br />❑ Geophysical Log(s) 950 How d �� Ciry State Zip <br />ass <br />❑ SoilMater Chemical Analyses 485165 <br />❑ Other site map Signe <br />C-57 Li water Well ontractor Date Signed C-57 License Number <br />Attach addition-) information it it exists. <br />SPAC\IS EEDED, USE NEXT CONSECUTIVELY NUMBERED FORM <br />r1WR 998 REV. 112006 IF ADDITIONAL <br />—. % -I <br />