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DUPLICATE sr,\,rE OF CA1,11FORNIA Driller's Copy WELL COMPLETION REPORT Page Of Rehr to Instruction Parupidrl • Ommett's Well leo. No. o ?A0459 Date Work B,1,an June 10 , 19 9 4 P.nded Local Permit Agenev San J O a G u i n Co. Health Dept, U 1 v% Q 17 Permit Date UVVN - VIVLY - UV IVV I 111E 1.1 i t _iLi I I I STATE WELL NO./STATION NO. LATITUDE LONGITUDE APN/TRS/OTHER GEOLOGIC LOG NVELL OWNER ORIENTATION VERTICAL _ HORIZONTAL _ ANGLE (SPECIFY) Nit] 11 Ey P r P t t it n k i n s DRILLING d B n on i to IaillncT Adrtt'etiti 1 fi�R 5!j Trac B V DEPTH FROM METHOD Mud Rotary FLUID �— ti T • (� 3 SURFACE DESCRIPTION CITM, rA r V r a STATE 6 ZIP Ft. to FL Describe material, ;,Frain siae, color, etc. T r ro LU DESTROY (Describe Procedures and Materials Under "GEOLOGIC LOG') PLA\\Ell USES (.�L ) XER SUPPLY Domestic Public Irrigation Industrial MONITORING TEST WELL CATHODIC PROTECTION HEAT EXCHANGE _ DIRECT PUSH _ INJECTION VAPOR EXTRACTION _ SPARGING SOUTH REMEDIATION Ilhralrale or Describe Di.siaucc If 'a ,It frwa Roads. Ruildiurs. I, ncc.v, /{ican, etc. mrd anach a 1110/I). US(' additional raper it OTHER (SPECIFY) ueces.san/. PLEASE BE ACCURATE' & C0d1P1,ET .. WATER LEVEL & YIELD OF COMPLETED 1VELL DEPTH TO FIRST WATER 301 (Ft.) BELOW SURFACE DEPTH OF STATIC WATER LEVEL (Ft.) & DATE MEASURED ESTIMATED YIELD' (GPM) & TEST TYPE TEST LENGTH (Hrs.) TOTAL DRAWDOWN (Ft.) ' .1lay not he representative of a wells- rind. DEPTH FROM SURFACE `1' `LLL 0 a DEPTH ANN"ULAR SIATERIAL FROM SURFACE TYPE MILL FILTER PACK C�TOII�)E Ft. to Ft (TYPE/SIZE) Address Bethany RK.TIO\ a '1. E. of Byron Hwy Cit,- Tracy 12 X PVC 611 CcntntY San J o a 4u i n 2.45 1285 12 AP\ Book Page Parcel 100 285 ToNviishih Range Section Latitude I I NORTH LOntitttlde I I WEST DEG. MIN. C. SE DEG. MIN. SEC. I LOCATION' SKETCH ACTI\'ITT (=L) — NORTH I —1 NEW WELL MODIFICATION/REPAIR _ Deepen _ Other (Specify) r ro LU DESTROY (Describe Procedures and Materials Under "GEOLOGIC LOG') PLA\\Ell USES (.�L ) XER SUPPLY Domestic Public Irrigation Industrial MONITORING TEST WELL CATHODIC PROTECTION HEAT EXCHANGE _ DIRECT PUSH _ INJECTION VAPOR EXTRACTION _ SPARGING SOUTH REMEDIATION Ilhralrale or Describe Di.siaucc If 'a ,It frwa Roads. Ruildiurs. I, ncc.v, /{ican, etc. mrd anach a 1110/I). US(' additional raper it OTHER (SPECIFY) ueces.san/. PLEASE BE ACCURATE' & C0d1P1,ET .. WATER LEVEL & YIELD OF COMPLETED 1VELL DEPTH TO FIRST WATER 301 (Ft.) BELOW SURFACE DEPTH OF STATIC WATER LEVEL (Ft.) & DATE MEASURED ESTIMATED YIELD' (GPM) & TEST TYPE TEST LENGTH (Hrs.) TOTAL DRAWDOWN (Ft.) ' .1lay not he representative of a wells- rind. DEPTH FROM SURFACE BORE HOLE DIA. (Inches) CASING (S) DEPTH ANN"ULAR SIATERIAL FROM SURFACE TYPE MILL FILTER PACK C�TOII�)E Ft. to Ft (TYPE/SIZE) TYPE () r z ¢ a MATERIAL / z w z� a GRADE g 0 �Q INTERNAL DIAMETER (Inches) GAUGE SLOT SIZE OR WALL IF ANY THICKNESS (Inches) Ft. to Ft. 0 245 12 X PVC 611 1600 0 100 X 2.45 1285 12 % PVC 6° 1600 1 4511000 100 285 r I I I I I ATTACHMENTS (iL ) _ Geologic Log Well Construction Diagram _ Geophysical Log(s) _ Soil/Water Chemical Analyses Other ATTACH ADDITIONAL INFORMATION. IF IT EXISTS, UEH'1lFIU'A1IO.N S'IA11i:MENI I, the undersigned, certify that this report is complete and accurate to the best of my knowledge and belief. NAME HENNINGS BROS. DRILLING CO.. INC. (PERSON, FIRM. OR CORPORATION) (TYPED OR PRINTED) 3525 PELANDALE AVE. MODESTO CA 95356 ADDRESS CITY STATE ZIP Signed �� `fi l �� - JULY 30.1998 2go All WELL DRILLER/AUTHORIZED REPRES TATIVE DATE SIGNED C-57 LICENSE NUMBER t IAt'H Iti1 REV. Ila' IF ADDITIONAL SPACE IS NEEDED, USE NEXT CONSECUTIVELY NUMBERED FORM