Laserfiche WebLink
'The free Adobe Reader may be used to view and comps form. However,software must be purchased to complete.*and reuse a saved form. <br /> File Original with DWR State of California DWR Use OM —Do Not Fill In <br /> Pae 1 of 1 Well Completion Report <br /> Page Refartolnstruction PampMe( r� State�Well�Numbrer�/Sfle Number <br /> Owner's Well Number VE-4 0/1 /2012 93 L—L—_L]IUGe L_L_L_ W <br /> Date Work Began 10/08/2012 Date Work Ended.10/19/2012 Latitude Lan nude <br /> Local Permit Agency San Joaouin County Environmental Health Department <br /> Permit Number 65824 Permit Date 10/2/12 APN/TRS/Other <br /> Geologic Log Well Owner <br /> Orientation OVertical 0Horizontal OAngle Specify Name Chevron <br /> Drilling Method Hollow Stem Auger Drilling Fluid <br /> Mailing Address 6101 Bollinger Canyon Rd <br /> Depth from Surface Description <br /> Feet to Feet Describe material,grain size,color,etc City San Ramon State CA lj 94583 <br /> 0 6 Silty clay with gravel,dark brown,silty clay with Well Location <br /> pea gravel. Address 508 West Charter Wa <br /> 6 10 Silt, light brown, loose to soft,moist. City Stockton County San Joaquin <br /> 10 14 Well-graded fine sand,yellowish brown, loose to Latitude N Longitude <br /> Soft, moist. Dea. Min. Sec. Dec. Min. Sec. <br /> 14 16 Silty clay, pale brown, non plastic,firm to stiff, Datum Decimal Lat. Decimal Long. <br /> moist. APN Book 165 Page .040 Parcel 16 <br /> Township —Range Section <br /> Location Sketch Activit <br /> Sketch must be drawn 0 hand after form is nntw O New Well <br /> North Q Modificabon/Repair <br /> O Deepen <br /> O Other <br /> — <br /> 0 Destroy <br /> ...,'GEOLOGIC <br /> Loot ,eiermi. <br /> uM.r'GEOIOGiG LOG' <br /> Planned Uses <br /> Q 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 /> Q Monitoring <br /> O Remediation <br /> Q Sparging <br /> South IO Test Well <br /> lnu.o-.wore„oneaavunrworwaufte,n,o.m.bmama..l-� G Vapor Extraction <br /> ai..,eIc .d:Itmh ... us..mab.a..P.ran......ry Q Other <br /> ...b..ccur.m.,,e.o,. i.,. <br /> Water Level and Yield of Completed Well <br /> Depth to first water (Feet below surface) <br /> Depth to Static <br /> Water Level (Feet) Date Measured <br /> Total Depth of Boring 16 Feet Estimated Yield' (GPM) Test Type <br /> Test Length (Hours)Total Drawdown (Feet) <br /> Total Depth of Completed Well 16 Feet *May not be representative of a well's long term yeld. <br /> Casings Annular Material <br /> Depth from Borehole Type Material Wall Outside Screen Slot Size Depth from <br /> Surface Diameter yp Thickness Diameter Type If Any Surface Fill Description <br /> Feel to Feet Inches Inches Inches Inches Feet to Feet <br /> 0 11 10 Blank PVC Sch.40 1 14 1 1 0 7 Cement <br /> 11 16 10 Screen PVC Sch.40 4 0.020 7 10 Bentonite <br /> 10 16 Filter Pack #3 sand. <br /> Attachments Certification Statement <br /> ❑Geologic Log 1,the undersigned,certify that this report is complete and accurate to the best of my knowledge and belief <br /> ❑ Well Construction Diagram Name National EOrP Inc <br /> Person,Firm or Corporation <br /> ❑ Geophysical Log(s) 14110 Cac ville Road YOlX CA 95695 <br /> ❑ Soil/Water Chemical Analyses AddressState Zip <br /> ❑� Other Site Mai) Sig cnr 2/14/13 953646 <br /> Attach additional information M it exists. -57 Licensee Water We ontreclor Date Signed C-57 License Number <br /> DWR 188 REV,1/2006 IF DOITIONAL SPACEIS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />