WP0037341 - Laserfiche WebLink

Home Browse Search

`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. File Original with DWR State of California DWR Use Only-Do Not Fill In Page 1 of 1 Well Completion Report Refer to Instruction Pamphlet State Well Number/Site Number Owner's Well Number No. e0358693 I I i I INI I J I I IW Date Work Began 10/23/2017 Date Work Ended 10/31/2017 Latitude Longitude Local Permit Agency SAN JOAQUIN COUNTY ENVIROMENTAL HEALTH 717-1-Flill 111 117 Permit Number WP0037341 Permit Date 10/6/17 APN/TRS/Other Geologic Log Well Owner Orientation @Vertical O Horizontal OAngle Specify Name LBA RV COMP. XIX LP Drilling Method Air Drilling Drilling Fluid Bentonite mud Depth from Surface Description Mailing Address P.O. BOX 847 Feet to Feet Describe material,grain size,color,etc City CARLSBAD State CA 7i 92018 0 22 BROWN CLAY Well Location 22 27 SAND Address 14900W. SCHULTE RD. 27 44 BROWN CLAY City TRACY County San Joaquin 44 57 SAND AND GRAVEL Latitude N Longitude ____�N 57 147 BROWN CLAY Deo. in. Sec. Deq. Min. Sec. 147 267 BLUE CLAY Datum Dec.Lat. Dec. Long. 267 280 BROWN CLAY APN Book 209 Page 240 Parcel 34 280 294 SAND Township -Range Section 294 309 BROWN CLAY Location Sketch Activity 309 314 SAND Sketch must be drawn b hand after form is rimed. @ New Well North O Modification/Repair 314 367 BROWN CLAY O Deepen 367 373 SAND O Other 373 385 BROWN CLAY O Destroy Describe procedures and materials under-GEOLOGIC LOG" Planned Uses @ Water Supply ❑� Domestic ❑Public cc w ❑Irrigation ❑Industrial O Cathodic Protection RFr.Fiv In O Dewatering O Heat Exchange O Injection O Monitoring E I O Remediation PERMITNEROCES O Sparging Soutn O Test Well Illustrate or describe distance of well from roads,buildingsO Vapor Extraction,fences, rivers,etc.and attach a map.Use additional paper if necessary. O Other Please be accurate and com tete. 361 363 DIELECTRIC COUPLING Water Level and Yield of Completed Well Depth to first water (Feet below surface) Depth to Static Water Level (Feet) Date Measured Total Depth of Boring 385 Feet Estimated Yield' (GPM) Test Type Total Depth of Completed Well 385 Feet Test Length (Hours) Total Drawdown (Feet) *May not be representative of a well's long term yield. Casings Annular Material Depth from Borehole Type Material Wall Outside Screen Slot Size Depth from Surface Diameter yp Thickness Diameter Type if Any Surface Fill Description Feet to Feet Inches Inches Inches Inches Feet to Feet 0 20 128 Conductor HSLA STEEL 1/4 24 0 1350 Cement SANITARY SEAL 0 363 18 Blank HSLA STEEL 1/4 85/8 350 385 Filter Pack GRAVEL 363 375 18 Screen STAINLESS 1/4 8 5/8 Louver 0.060 375 385 18 Blank STAINLESS 1/4 85/8 Attachments Certification Statement ❑ Geologic Log I,the undersigned,certify that this report is complete and accurate to the best of my knowledge and belief ❑Well Construction Diagram Name QUALITY WELL DRILLERS Person,Firm ❑ Geophysical Log(s) 260 AIRPARK RDrCoporation ATW TER CA 95301 ❑ Soil/Water Chemical Analysesddress City State Zip ElOther Signed 12-6-2017 468732 Attach additional information if it exists. C-57 Licensed Water Well Contractor Date Signed C-57 License Number DWR 188 REV.1/2006 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM