Laserfiche WebLink
`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. <br /> File Original with DWR <br /> State of California DWR Use Only-Do Not Fill In <br /> Page 34 of 42 Well Completion f�leport <br /> Owner's Well Number EW-3 Refer to IrGd. bn pampnet <br /> Date Work Began 09/24/2012 <br /> NO. e0162849 State Well Number/Site Number <br /> Date Work Ended 10/1/ 01 -L-_1._. N <br /> Local Permit Agency Joaouin .otnh Environme f I —��-'- Lahlude --L-A:l nude W <br /> Permit Number NA <br /> -�_ Permit Date <br /> —� APN/rRS/Other <br /> Geologic Lo <br /> Orientation OVenical OHorizontal Well Owner <br /> Drilling Method Hollow Stem Au er O ling Specify <br /> Drilling Fluid Bentonite mud Nalene <br /> Depth from Surtace Description Mailing Address <br /> Feet to Feet Describe material rain size,color,etc Ci'. <br /> 25 0 Pressure Grout State 7i <br /> Well Location <br /> Address 6431 West Banner Street <br /> City Lodi County San Joaquin <br /> Latitude N Longitude <br /> Dea Min. Sec. Deo. Min. -Sec--W <br /> Datum Decimal Lat, Decimal Long. <br /> APN Book Page Parcel <br /> To;Mnsl i Range Section <br /> Location Sketch Activit <br /> ketch must be drawn byhard II f titin is rintetl. <br /> North O New Well <br /> O Modification/Repair <br /> O Deepen <br /> O Other <br /> O Destroy <br /> 0"tafl a wocedIaes and materna <br /> - — <br /> ander'GEOLOGIC LOG' <br /> — Planned Uses <br /> yyy O Water Supply <br /> ❑Domestic ❑Public <br /> w ❑Irrigation ❑Industrial <br /> _ 0 Cathodic Protection <br /> _ O Dewatering <br /> -_ O Heat Exchange <br /> O Injection <br /> O Monitoring <br /> _. O Remediation <br /> O Sparging <br /> South O Test Well <br /> !tero;,a m destine aintwwn al.eu n.an roam.MAdinea.ranca.. O Vapor Extraction <br /> e.can end.lbub... use......n <br /> el paPo/Il neceaaary. O Other <br /> — <br /> 0! <br /> be accurate and ciete. <br /> alar Level and Yield of Completed Well <br /> Depth to first water <br /> Depth to Static (Feet below surface) <br /> Total Depth of Boring 25Water Level (Feet) Date Measured <br /> Feet Esti Tatted Yield` (GPM) Test Type <br /> Total Depth of Completed Well 25 Feet Tesi Length (Hours) Total Drawdown <br /> _(Feet) <br /> "Ma not be re resentative of a well's Ion term ield. <br /> Depth from Borehole <br /> Casings Annular Material <br /> Wall Outside Screen Slot Size Depth from <br /> Surface Diameter Type Material Thickness Diameter Typv If Any Surface <br /> Feet to Feet Inches Inches Inches Fill DescriptionInches Feet to Feet <br /> Attachments Certification Statement <br /> ❑ Geologic Log I,the undersigned,certify that this reVort is complete and accurate to the best of my knowledge and belief <br /> ❑ Well Construction Diagram Name All Well Abandonment <br /> 13 Geophysical Log(s) Parson,Firm or Corporation <br /> ❑ Soil/Water Chemical Analyses 9245 Beattv DAdareS ite A _ Sacr ento CA 95826 <br /> 0 Other Site MaD Signed I - rip <br /> Attach additional information eueasu. q 10/23/2012 848359 <br /> DWR 188 REV1(1006 <br /> cense ater Wall Coraracmr Date Si ned C-57 License Number <br /> . IF ADDITIONAL SPACE IS NEEDED.USE NEXT CONSECUTIVELY NUMBERED FORM <br />