Laserfiche WebLink
QUADRUPLICATE STATE OF CALIFORNIA DWR USE QNLY — DO N T FILL IN <br /> For Local Requirements WELL COMPLETION REPORT <br /> Page I of 1 Refer to Instruction Pamphlet STATE WELL NO./STATION NO. <br /> Owner's Well No. 95212 NO.e0352920 11 11 ID111 <br /> Date Work Began 9/13/2017 Ended9/14/2017 LATITUDE LONGITUDE <br /> Local Permit Agency Environmental Health <br /> Permit No. wp0037299 Permit Date 9/11/2017 APN/TRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(✓) VERTICAL —HORIZONTAL —ANGLE —(SPECIFY) Name Nancy Cuneo <br /> DRILLING ROTARY <br /> DEPTH FROM METHOD FLUID Mud Mailing Address 9263 Nassano Dr <br /> DESCRIPTION Stockton CA 95212 <br /> Ft. to Ft. Describe material, grain, size, color, etc. CITY STATE zip <br /> 0 3 Top Soil VE <br /> Address 9263 Nassano Ur LL LOCATIO <br /> 3 8 Clay City Stockton CA 95212 <br /> 8 14 Sand CountySan Joaquin <br /> 14 1131 Clay APN Book Page Parcel <br /> 113 1151 Sand Township Range Section <br /> 115 123 Clay Latitude I 1 <br /> 123 134 Sand DEG. MIN. SEC. DEG. MIN. SEC. <br /> 134 140 Clay LOCATION SKETCH ACTIVITY (✓) <br /> 140 143 Sand NORTH _Iv" NEW WELL <br /> MODIFICATIONIREPAIR <br /> 143 150 Shale —Deepen <br /> 150 172 Sand —Omer(Specify) <br /> 172 179 Clay <br /> Describe <br /> 179 185 Sand Prrocedures OY and Materials <br /> Under"GEOLOGIC LOG" <br /> 185 210 Clay PLANNED USES() <br /> 210 213 Sand WATER SUPPLY <br /> 213 225 Clay c y —,L Domestic— Public <br /> 225 230 Sand ul —ul Irrigation — Industrial <br /> 230 265 Clay 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&YIELD OF COMPLETED WELL <br /> DEPTH TO FIRST WATER (FL)BELOW SURFACE 1 <br /> DEPTH OF STAT68 <br /> WATER LEVEL �8 (Ft.)&DATE MEASURED 9/14/2017 <br /> TOTAL DEPTH OF BORING 265 ESTIMATED YIELD ' (GPM)& TEST TYPE <br /> (Feet) TEST LENGTH (Hrs.) TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL 240 (Feet) I May not be representative o a well's long-term yield. <br /> DEPTH BORE <br /> - CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE HOLE TYPE ✓) FROM SURFACE TYPE <br /> DIA. Yw o MATERIAL/ INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> (Inches) Z _ O a GRADE DIAMETER OR WALL IF ANY FILTER PACK <br /> Ft. to Ft. m v (Inches) THICKNESS (Inches) Ft. o Ft. MENT TONT FILL (TYPE/SIZE) <br /> to LL ✓ (i�) (✓) <br /> 0 220 11 <br /> 220 240 45 100 240 � 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, ,QRPORATION) (TYPEpR „IN EDS <br /> — Soil/Water Chemical Analysis 119 A AI - `<a Modesto CA 95357 <br /> — Omer ADDRESS CITY STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION,IF IT EXISTS. 11 Signed s. + 09/20/17 668622 <br /> WELL DRILLER/AUTHORIZED RWRESENTANVE F DATE SIGNED C-57 LICENSE NUMBER <br /> DWR 188 REV.11-97 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />