Laserfiche WebLink
'The free Adobe Reader may be used to view and complete this form. However.Sollware most 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 /> Well Completion Report <br /> Page 1 of 2 Relerlo Mseuceon Pamichiat State Well Numben'Stts Number <br /> Owner's Well Number MW-6 No. e0101004 m7 <br /> Date Work Began 10/28/2009 Date Work Ended 10/28/2009 Latitude Lan iblde <br /> ' Local Permit Agency San Joaouln County Environmental Health Department <br /> Permit Number 057999 Permit Date 817109 APWTRSIOther <br /> Geologic Log Well Owner <br /> Orientation OVeNcal 0Horizontal OAngle Specify Name CEMC <br /> Drilling Method Hollow Stem Auger Ddlhng Fluid Meiling Address 6111 San Ramon Road,BR1Y3432 <br /> Depth tram Surface Description San Ramon CA 94583 <br /> Feet to Feet Describe material. rain size,color,etc C' State_2i <br /> 0 32 Neat cement orout Well Location <br /> ' Address 26501 Banta Road <br /> City Lvoth County San Joaquin <br /> Latitude N Longitude <br /> Dear W. Sea. Daa. Mn. Sea. <br /> Datum Decimal Let. Decimal Long. <br /> APN Book 252 Page 010 Parcel 06 <br /> Township 3.S RanQB 5E Section 35 <br /> Location Sketch Activity <br /> skemh mW ee by hand ase,farm is qr,e 0New Well <br /> North O Modification/Repair <br /> O Deepen <br /> 1eOther <br /> De <br /> � stroy <br /> passe.renown ela,vrvae <br /> wGn'aEOLOpIC cam' <br /> Planned Uses <br /> — O Water Supply <br /> ❑Domestic []Public <br /> 3 w ❑Irrigation []Industrial <br /> O Cathodic Protection <br /> O Dewatering <br /> O Heat Exchange <br /> O Injection <br /> O Monitoring <br /> O Remediation <br /> O Spangling <br /> South O Test Well <br /> a.naleo-ueaemaaawwu.ei�ar wn,y;laaPra. 0 Vapor Extraction <br /> ' _a.,e aaau aR,aF uw ae4m,yommn. rr,«.:m, O Other <br /> Pbn Oa¢cuMUM cam Ietr <br /> Water Level and Yield of Completed Well <br /> Depth to first water (Feet below surface) <br /> Depth to Static <br /> 1 Water Level 15 (Feet) Date Measured 10/28/2009 <br /> Total Depth of Boring 32 Feet Estimated Yield• (GPM) Test Type <br /> Total Depth of Completed Well 30.4 Feet Test Length (Hours) Total Drawdown_(Feet) <br /> 'May not be re resentative of a well's long term yield. <br /> Casings Annular Material <br /> Depth from Borehole Type Material Wall Outside Screen Slot St. Depth from <br /> Surface Diameter yp Thickness Diameter Type If Any Surface Fill Description <br /> Feet to Fast Inches Inches inches Inches Feet to Feet <br /> Attachments Certification Statement <br /> ❑Geologic Log 1.the undersigned,ce tity that this report is complete and accurate to the best of my knowledge and belief <br /> ' ❑Well Construction Diagram Name RSI Drilling.Inc. <br /> ❑Geophysical Log(s) 20 NoPherean,FNm or CoryomlAn <br /> — <br /> Ea t St r et Woodland CA 95776 <br /> ❑ SOIWVater Chemical Analyses edreas Cay sure zo <br /> O Other Site Mao showing well location Signed 11/12/09 802334 <br /> ' Aaedl xeO,avnal ir,forro,torL e It esisu Car Lkeased We ed Conuacto, Date Signed C57 License Number <br /> DWR 188 REV."2006 IF ADDITIONAL SPACE IS NEE D,USE NEXT CONSECUTNELY NUMBERED FORM <br />