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.I STATION NO. <br /> Owner's Well No. 95366 NO.e0348022 <br /> Date Work Began 7/11/2017 Ended7/12/2017 I LATITUDE LONGITUDE <br /> Local Permit Agency Environmental Health L I I I I I I I I I l I___L___. <br /> 77658 6/6/2017 APNtrRSIOTHER <br /> Permit No. Permit Date _ __ <br /> GEOLOGIC LOG WELL OWNER — <br /> ORIENTATION(V) VERTICAL —HORIZONTAL — ANGLE —(SPECIFY) Name Caroll Heatwole <br /> DRILLING <br /> DEPTH FROM METHOD ROTARY FLUID Mud Mailing Address P.O. BOX 1176 <br /> SURFACEDESCRIPTION Ripon CA 95366 <br /> Ft. to Ft. Describe material, grain, size, color, etc. CITE STATE ZIP <br /> 0 3 1 Top Soil 12927E West Ron CATION <br /> 3 57 ClayAddress - p <br /> Sand City Ripon CA 95366 <br /> 57 82 <br /> 82 115 Sand <br /> CountySan Joaquin <br /> APN Book Page Parcel <br /> 115 130 Shale Township Range Section <br /> 130 132 Sand Latitude ' I I , _ <br /> 132 144 Clay DEG. MIN. SEC. DEG. MIN. SEC. <br /> 144 154 Sand LOCATION SKETCH ACTIVITY (v–) <br /> 154 170 Shale NORTH V NEW WELL <br /> 170 175 Sand MODIFICATIONIREPAIR <br /> —Deepen <br /> 175 181 Clay —Other(Specify) <br /> 181 189 Sand <br /> DESTROY 189 210 Blue Clay — Procedures escribe a0nd Materials <br /> Under"GEOLOGIC LOG' <br /> PLANNED USES() <br /> WATER SUPPLY <br /> H <br /> U) N Domestic_ Public <br /> Uj <br /> Irrigation — Industrial <br /> MONITORING— <br /> TEST WELL <br /> ATHODIC PROTECTION— <br /> HEAT EXCHANGE— <br /> DIRECT PUSH— <br /> INJECTION— <br /> VAPOR EXTRACTION— <br /> SPARGING <br /> SOUTH REMEDIATION— <br /> Illustrate or Describe Distance of Well from Roads, Buildings, <br /> Fences,Rivers,etc. and attach a map. Use additional paper if OTHER(SPECIFY)— <br /> necessary.PLEASE BE ACCURATE & COMPLETE. <br /> WATER LEVEL&YULD OF COMPLETED WELL <br /> DEPTH TO FIRST WATER (Ft.)BELOW SURFACE 1 <br /> DEPTH OF STATJ8 7/12/2017 <br /> WATER LEVEL�Sd�(Ft.)&DATE MEASURED <br /> ESTIMATED YIELD ' (GPM)& TEST TYPE <br /> TOTAL DEPTH OF BORING 210 (Feet) TEST LENGTH—(Hrs.) TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL 195 (Feet) Mav not be representative o a well's long-term vield. <br /> DEPTH BORE- CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE HOLE TYPE �) FROM SURFACE PIE <br /> DIA. Y ,� o- MATERIAL I INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> (Inches) Z Lu O a GRADE DIAMETER OR WALL IF ANY MENT TONIT FILL FILTER PACK <br /> Ft o Ft m o (Inches) THICKNESS (Inches) Ft to Ft. U (TYPE/SIZE) <br /> U) W0 175 11 VI I I PLASTIC 6 200 0 100 <br /> 175 195 100 195 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,FIRM,OW@QRPORATIONk4IjYPEDOP d <br /> — Soil/Water Chemical Analysis 119 AI R Iffito CA 95357 <br /> — Other ADDRESS CITY STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION,IF IT EXISTS. Signed 07/24/17 668622 <br /> WELL DRILLER/AUTHORIZED R%VSENTAIVE DATE SIGNED C-57 LICENSE NUMBER <br /> DWR 188 REV.11-97 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />