Laserfiche WebLink
QUADRUPLICATE STATE OF CALIFORNIA DWR USE ONLY — DO NOT FILL IN <br /> For Local Requirements WELL COMPLETION REPORT <br /> Page 1 of 1 Refer to Instruction Pamphlet STATE WELL NO./STATION NO. <br /> Owner's Well No. 95215 NO.e0358364 III , I DEI 1111 1 <br /> Date Work Began 11/13/2017 Endedll/14/2017 LATITUDE LONGITUDE <br /> Local Permit Agency Fnvimnmental Health <br /> Permit No. wp0037552 Permit Date 11/2/2017 APNIrRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(✓) –tL VERTICAL —HORIZONTAL —ANGLE —(SPECIFY) Name Moorman's Water Systems <br /> DRILLING ROTARYMailing <br /> DEPTH FROM METHOD FLUID Mud Stockton Address 2120 Wilcox Rd CA 95215 <br /> SURFACEDESCRIPTION <br /> FL to Ft. Describe material, grain, sue, color, etc. CITE STATE ZIP <br /> 0 2 Top Soil Address 20980E Hwy 26W <br /> Gravel ELL LOCATIO <br /> 2 10 Gr City Linden CA <br /> 10 14 CountySan Joaquin <br /> 14 221 Clay APN Book Page Parcel <br /> 22 43 1 Gravel and Rocks Township Range Section <br /> 43 581 Clay Latitude I 1 1 <br /> 58 62 Gravel DEG. MIN. SEC. DEG. MIN. SEC. <br /> 62 143 Clay LOCATION SKETCH ACTIVITY (�) <br /> NORTH --V-" NEW WELL <br /> 143 153 Sand <br /> 153 164 ClayMODIFICATION/REPAIR <br /> —Deepen <br /> 164 175 Sand —other(Specify) <br /> 175 203 Clay <br /> — DESTROY(Describe <br /> 203 220 Gravel Procedures and Materials <br /> Under"GEOLOGIC LOG" <br /> 220 238 Clay PLANNED USESO <br /> 238 243 Sand WATER SUPPLY <br /> 243 255 Clay W ; Domestic— Public <br /> 255 280 Sand L InigaUon _ Industrial <br /> 280 292 Clay MONITORING— <br /> TEST WELL_ <br /> 292 295 Sand ATHODIC PROTECTION- <br /> 295 304 Clay HEAT EXCHANGE- <br /> 304 310 Black Sand DIRECT PUSH- <br /> 310 348 Clay INJECTION— <br /> VAPOR EXTRACTION— <br /> 348 350 Black Sand SPARGING_ <br /> 350 395 Clay SOUTH REMEDIATION— <br /> 395 400 Black Sand Illustrate or Describe Distance of Well from Roads, Buildings, <br /> Fences,Rivers,etc. and attach a map. Use additional paper if OTHER(SPECIFY)— <br /> 400 418 Shale necessary. PLEASE BE ACCURATE & COMPLETE. <br /> 418 453 Black Sand WATER LEVEL&YIELD OF COMPLETED WELL <br /> 453 463 Shale DEPTH TO FIRST WATER (Ft.)BELOW SURFACE <br /> 463 471 Gravel DEPTH OF STATIC <br /> 471 503 Shale WATER LEVEL 166 (Ft.)&DATE MEASURED 11/14/2017 <br /> ESTIMATED YIELD (GPM)& TEST TYPE <br /> TOTAL DEPTH OF BORING 503 (Feet) TEST LENGTH—(Hrs.) TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL460 (Feet) Mav not be representative of a well's Jori -term yield. <br /> DEPTH BORE- CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE HOLE a:T�PE _!L FROM SURFACE PE <br /> DIA. MATERIAL/ INTERNAL GAUGE SLOT SIZE(Inches) GRADE DIAMETER OR WALL IF ANY CE- BEN- FILTER PACK <br /> Ft. to Ft (Inches) THICKNESS (Inches) Ft_ to Ft. MENT TONIT FILL <br /> � (✓) U (TYPE/SIZE) <br /> 0 380 21 <br /> 380 4601 -11 1 .045 50 460 GRAVEL <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 MASELLIS DRILLING INC <br /> — Geophysical Log(s) (PERSON,FIR OR CORPOR N) (T.YD) <br /> — Soil/Water Chemical Analysis 119 Albers R t'` $ 95357 <br /> Other ADDRESS „ys CITY STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION,IF IT EXISTS. Signed 12/06/17 668622 <br /> WELL DRILL R/AUTHORIZ PRESE ATIVE DATE SIGNED C-57 LICENSE NUMBER <br /> DWR 188 REV.11-97 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />