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ORIGINAL STATL Ot• (ALIT OItNIA w R Y — F r 1 <br /> Rile with DWR WELL COMPLETION REPORT D 4 <br /> Page 1 of 1 Refer ro Inrlrudrion Pampbler STATE WELL NO!STATION NO <br /> Owner s Well No SG-07 No11 <br /> Date Fork Began 9/24/96 Ended �` 6,' P P30LATITUDE ❑ LONGITUDE <br /> Local Permit Agency San Joaquin County Public Health Seryl ces <br /> Permit No 10404 _Permit Date P ! t <br /> OTHEE <br /> —r GEOLOGIC LOG WELL OWNER <br /> ORIENTATION (L VERTICAL _ HORIZONTTAL� ANGLE — (SPECIFY) Nam, Southern Pa 1 f7 Tr n5 <br /> DEPTH FROM <br /> DEPTH TO FIRST WATER N/A--(Ft) BELOW SURFACF Mailing Address One Market Plaza SURFACE DESCRIPTION San Francisco CA <br /> 24105 <br /> Ft to Ft Describe maierral Rrarn size color etc CITY STATE ZIP <br /> WELL LOCATION <br /> Address 780 East 6th Street <br /> cit. Tracy <br /> County San Joaguin <br /> APN Bonk Page Parcel <br /> Township 2S Range 5—Section 27_ <br /> See Attached Well Construction IoQ LatitudeDEG MIN SEC bEG MIN SEC I --NORTH Longitude WEST <br /> ' <br /> LOCATION SKETCH ACTIVITY (4) <br /> NORTH NEW WELL <br /> MODIFICATION/REPAIR <br /> r <br /> —Deepen <br /> Other(Specify) <br /> See Attached Site Map <br /> ' DESTROY(Describe <br /> Procedures andMefansls <br /> ' Under GEOLOGICLOG) <br /> PLANNED USE(S) <br /> w <br /> W MONITORING <br /> ' WATER SUPPLY <br /> , <br /> Domestic <br /> Public <br /> ' Irrigation <br /> industrial <br /> TEST WELL <br /> CATH0131C PROTEC <br /> SOUTHTION <br /> Illustrate or Describe Distance of Well from Landmarks OTHER(Speedy) <br /> such as Roads Buildings Fences Rrocrs etc <br /> PLEASE HE ACCURATE & COMPLETE 3all Gas <br /> DRILLING <br /> METHOD Di rest Push FLUID <br /> WATER LEVEL & YIELD OF COMPLETED WELL <br /> DEPTH OF STATIC <br /> WATER LEVEL NIA (Ft) & DATE MEASURED <br /> ESTIMATED YIELD* (GPM) a TEST TYPE <br /> TOTAL DEPTH OF BORING (Feet) TEST LENGTH (Hra) TOTAL DRAWDOWN (Ft) <br /> TOTAL DEPTH OF COMPLETED WELL (Feet) "May not be representative of a well's long-term yield <br /> DEPTH CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE BORE TYPE ✓ FROM SURFACE TYPE <br /> HOLE — INTERNAL GAUGE SLOT SIZE <br /> a: <br /> DIA W x MATERIAL/ CE BEN <br /> o d <br /> DIAMETER OR WALL IF ANY FILTER PACK <br /> (inches) c a GRADE MENT TONITE FILL <br /> F1 to Ft N vao (Inches) THICKNESS (Inches) Ft to Ft (✓ ) (✓ ) (✓ ) (TYPEISIZE) <br /> 0 5.5 2-3/8 X PVC 1 Schedule ZO 0 3.5 X <br /> 5.5 9.5 2-3/8 X1 I PVC 1 Schedule <br /> ATTACHMENTS (!) CERTIFICATION STATEMENT <br /> I the undersigned certify that this report is complete and accurate to the best of my knowledge and belief <br /> Geologic Log <br /> 1� Well Construction Diagram NAME <br /> (PERSON FIRM OR CORPORATION) (TYPED R PAINTED) <br /> Geophyaital Logi(s) <br /> Soil'Weller Chemical Analyses 983R_Ol rl PP�1 aroryt i 11 1 a Rriarl GUS t8 100• Ran aigg1:3-..o !'A _ 998ip <br /> Other ADD SS CITY 1fF <br /> ATTACH ADDITIONAL INFORMATION IF IT EXISTS Slpned <br /> WELL DRILLER AUTHORIZED REPRESENTATIVE DATE SIG Q C 57 LICENSE NUMBER <br /> DW((INhi1EN 7 LII IF ADDITIONAL SPACE IS NEEDED USE NEXT CONSECUTIVELY NUMBERED FORM <br />