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 DVVR Use Only–Do Not Fill In <br /> Well Completion Report --- <br /> Page 1 of 1 - T.... <br /> Refer to InStrucfion Paml Met I I I I I 1 I <br /> Owner's Well Number VW-1 No. e0301556 Sta�umb-r/Site Number <br /> Date Work Began 01/13/2016 Date Work Ended 1/20/2016 L <br /> -L N _.1_> _1 A� <br /> Local Permit Agency-San Joaauin Countv nvironmental Hlth nlnt — tudePermit Number SR0073506 <br /> Permit Date 10/27/15 APN/rRs/other <br /> eolo <br /> Orientation O Vertical Gis Loa <br /> Well OwnerO Horizontal OAngle Specify <br /> Drilling Method Hollow Stem Au er Name Swaran Chouhan <br /> Drilling Fluid Bentonite mud <br /> Depth from Surface Description Mailing Address 1632 Paola Place <br /> Feet to Feet Describe material,grain size,color,etc �',lty Manteca <br /> 36 0 State CA 7i 95337 <br /> Drilled out to total de th utilizing a truck mounted <br /> CME-75 with 8-inch hollow stem augers Well Location <br /> Address 701 East Charter Avenue <br /> City Stockton County San Joaquin <br /> Latitude N Longitude <br /> Deo Mm Sec. Dec Min Sec. W <br /> Clatum Dec.Lat. Dec.Long. <br /> APN Book 147 Page 343 Parcel 11 <br /> Townshi Range Section <br /> Location Sketch Activity <br /> Sketch must be drawn by hand after form is printecl0 New Well <br /> North Modification/Repair <br /> O Deepen <br /> O Other <br /> 0 Destroy <br /> Oesaibe procedures and materials <br /> un0,'GEOLOGIC LOG' <br /> Planned Uses <br /> O Water Supply <br /> [:]Domestic ❑Public <br /> ❑Irrigation ❑Industrial <br /> w <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 /> ulus rate or describe distance of welt from roads.buildings.fences. O Vapor Extraction <br /> rivers,etc and attach a map use additional paper d necessary t� Other <br /> Please be accurate and complete <br /> ater 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 36 Feet Es:imated Yield' (GPM) Test Type <br /> Total Depth of Completed Well 36 Feet Test Length (Hours) Total Drawdown (Feet) <br /> M ay not be representative of a well's long term yield. <br /> Casin s Annular Material <br /> Depth from Borehole Wall Outside Screen Slot Size Depth from <br /> Surface Diameter Type Material Thickness Diameter Type if An <br /> Feet to Feet Inches Inches Inches y Surface Fill Description <br /> Inches feet to Feet <br /> Attachments Certification Statement <br /> ❑Geologic Log rName <br /> ersigned,certify that this report is complete and accurate to the best of my knowledge and belief <br /> ❑ <br /> Well Construction Diagram ll Well Abandonment <br /> Geophysical Logs) PersonFirm orcorporationSoil/Water Chemical Analyses itzaeralAddress RoadRanchoCorova CA 95742 <br /> 121 Ct Zip <br /> Other Site Mao ro 2/22/2016 848359 <br /> Attach additional information if it exists. -5 W tefVvefl riractor <br /> DWR 188 REV.it4008 Date Signed C-57 License Number <br /> IF ADWIONAL SPAC. S NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />