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UMU114AL STAT I: Of C ALIT ORNIA W R USE ONLY T F I <br /> File iiiii DWFj WELL COMPLETION REPORT <br /> Page 1 <br /> 1 O{ Refer to Instruction Pamphlet STATE WELL NO 15 AR NNO <br /> Owner`s Well No SG-08 No � � ^� { � u 0 <br /> Date Wort, Began Q1241Q6 Ended 9124196 " ` " `� LATITUDE LONGITUDE <br /> Lo(al Permit Agency <br /> Permit No 10404 <br /> Permit Date 9.112J915 APNITRSi R <br /> GEOLOGIC LOG W ELL OK NER <br /> ORIENTATION (✓) _X_ VERTICAL - HORIZONTAL _ ANGLE (SPECIFY) Name <br /> DEPTH TO FIRST %ATEH A (Ft) BELOW SURFACE Mailing Address One Market Pja7a <br /> DEPTH FROM <br /> ---- <br /> SURFACE DESCRIPTION San Franczsc(5 CA 94105_ <br /> Ft t0 Ft Describe material,grain size color, etc CITY STATE ZIP <br /> WELL LOCATION <br /> Address 780 Past 6th Street <br /> City Tracy <br /> County San ,Joagu_ill...-- — <br /> APN Book. Page Parcel <br /> or <br /> Township___2S Mange 5E Section <br /> or <br /> Latitude I NORTH Longitude I I WEST <br /> DEG MIN SEC DEG MIN SEC <br /> LOCATION SKETCH ACTIVITY (.!!L) <br /> See Attached NORTH _X NEW WELL <br /> Well Construction Log MODIFICATION tREPAIR <br /> AeePen <br /> , <br /> Other(Speaty) <br /> , <br /> See Attached Site Map <br /> DESTROY(Descnbe <br /> Procedures and MRteriete <br /> Under GEOLOGICLOG) <br /> N PLANNED USE(S)- <br /> (.:L) <br /> SES)(:) <br /> 3: W MONITORING <br /> , WATER SUPPLY <br /> , <br /> Domestic <br /> Public <br /> Irrigation <br /> Industrial <br /> ' TEST WELL <br /> �..._. CATHODIC PROTEC <br /> SOUTH TION <br /> Illustrate or Describe Distance of Well from Landmarks OTHER(specify) <br /> such as Roads Buildings Fences Rivers etc <br /> PLEASE BE ACCURATE v COMPLETE Mniri to <br /> DRILLING ng Fol nt <br /> METHOD Direct Pntz-h _ FLUID <br /> WATER LEVEL & YIELD OF COMPLETED WELL <br /> DEPTH OF STATIC n a <br /> WATER LEVEL (Ft} & DATE MEASURED <br /> ESTIMATED YIELD' (GPM) & TEST TYPE <br /> TOTAL DEPTH OF BORING __9 S (Feet) TEST LENGTH (Hrs) TOTAL DRAWDOWN (Ft) <br /> TOTAL DEPTH OF COMPLETED WELL .-_--_ 9.5 (Feet) *May not be representative of a wells long-term yaeld <br /> DEPTH CASING(S) DEPTH ANNULAR MATERIAI <br /> FROM SURFACE BORE <br /> HOLE TYPE <br /> x FROM SURFACE TYPE <br /> INTERNAL GAUGE SLOT SIZE <br /> DIA °c ii MATERIAL/ CE BEN <br /> (Inches) o� J GRADE DIAMETER OR WALL IF ANY MENT TONITE FILL FILTER PACK <br /> Ft to Ft m r o (Inches) THICKNESS (Inches) Ft to Ft (� ) (� ) ( L) (TYPElSIZE) <br /> , <br /> r <br /> ATTACHMENTS (✓) CERTIFICATION STATEMENT <br /> �/ Geologic Lou I the undersigned certify that this report Is complete and accurate to the best of my knowledge and belief <br /> ._p Well Construction Diagram NAME Camilla K. Williams, Terranext <br /> GeophysicalLog(a) (PERSON FIRM OR CORPORATION) (TYPED OR PRINTED) <br /> 50111water✓^ihemtcalAnalyses 9838 Old Placerville Road, Suite 100, Sacramento, CA 95827 <br /> Otherel <br /> ADDRESS CITY STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION IF IT EXISTS Signed _ . _ 0 <br /> WELL DRILLER AUTHORIZED REPRESENTATIVE ATE SIG D C51 LICENSE NUMBER <br /> DWR 189 REV T 90 IF ADDITIONAL SPACE IS NEEDED USE NEXT CONSECUTIVELY NUMBERED FORM <br /> c1 <br />