Laserfiche WebLink
'The free Adobe Reader Maybe 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 State of California DWR Use Only-Do Not Fill In <br /> Page 37 of 42 Well Completion Report I I I 7�-r-�—�—� <br /> Referm Instrodion pampNe! <br /> Owner's Well Number EW-6ANo. e0162852 State Well Number/Site Number <br /> Date Work Began 09/24/2012 Date Work Ended 10/1/2012 —/-- t N _J_1 NI <br /> Local Permit Agency San Joact_in o nh 1= '— Latitude Lon imda <br /> s' onm nt-I H lth D o rtPI t <br /> Permit Number NA Permit Date APN/TRS/Other <br /> Geologic LogWell Owner <br /> Orientation @Vertical L)Horizontal OAngle Speedy <br /> Drilling MethodHollow stem Auger Name <br /> Drilling Fluitl Bentonite mud <br /> Depth from Surface Description Mailing Address <br /> Feet to Feet Describe material, rain size,color,etc C[ State- -e <br /> 25 0 Pressure Grout ' <br /> lip <br /> Well Location <br /> Address 6437 West Banner Street <br /> City Lodi County San Joaquin <br /> La:itude N Longitude <br /> Det Min. Sec. Deo. Min. Sec' W <br /> Datum Decimal Let. Decimal Long. <br /> APN Book Page Parcel <br /> O:Nnshi Rance Section <br /> Location Sketch Activit <br /> sketch most be drawn by hard after farm is pnnied. O New Well <br /> North O Modification/Repair <br /> O Deepen <br /> 0 Other <br /> — <br /> 0 Destroy <br /> oeaaiba Praeadae.and melmaln <br /> untler'GEOLGGIL LOG' <br /> Planned Uses <br /> (1 O Water Supply <br /> ❑Domestic ❑Public <br /> ❑Irrigation []Industrial <br /> O 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 /> mem<re or deaanbe deanceot.ree nom reads,bmldho.le,ces O Vapor Extraction <br /> iiae,no.arid.nhamap use additional Pape,Ilneceeaar, @Other <br /> m <br /> sn be aceurah end corn ka. <br /> star Level and Yield of ComPlated Well <br /> Dep:h to first water (Feet below surface) <br /> De; It to Static <br /> Waller Level (Feet) Date Measured <br /> Total Depth of Boring 25 Feet Estimated Yield' (GPM) Test Type <br /> Total Depth of Completed Well 25 Feet Test Length (Hours) Total Drawdown_(Feet) <br /> 'Marr not be re resentative of a well's long term yield, <br /> Casings Annular Material <br /> Depth from Borehole Wall Outside Screel Slot Size Depth from <br /> Surface Diameter Type Material <br /> Feet Thickness Diameter Type If Any surface Fill Description <br /> to Feet Inches Inches Inches Inches Feet to Feet <br /> Aftachments 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 All Well Abandonment . <br /> ❑ Geophysical Log(s) Person,Firm or Corporation <br /> 9245 Beatt Drive Suite A Sacramento CA 95826 <br /> ❑ SoiVWater Chemical Analyses Addres <br /> IZI Other Site Mao Signed !� —�— State zip <br /> 0/23/2012 848359 <br /> Attach additional information,Rit exists. nor 60iied Water Ve,Cantmnx Date Signed C-57 License Number <br /> DNR 188 REV.12ODe IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />