Laserfiche WebLink
ORIGINAL STAT'r Or C ALII 0IiN1AN Y — D N T F I IN <br /> File with DWR WELL COMPLETION REPORTM SATE WELL NO 11 oN NO <br /> Page 1 of Refer ro Insrruction Pamphlet ❑ ❑ <br /> Owner's Well No _SQ-15 No /C p '7 <br /> Date Wort Began 9/25/96 _ Ended '' o LATITUDE LONGITUDE <br /> Local Permit Agency San Joaquin County pu61 i c Health Services <br /> is Permit No _ 10404 Permit Date —_9.119.19F P r , <br /> GEOLOGIC LOG "ELL OH NER <br /> ORIENTATION (!) VERTICAL — HORIZONT�A�L��— ANGLE — (SPECIFY) Name <br /> DEPTH FROM <br /> DEPTH TO FIRST WATER +.�L.,i"!._(Ft) BELOW SURFACE Mailing Address Qne Market Pla 7a <br /> SURFACE DESCRIPTION San Francisco <br /> Ft to Ft Describe Tnaterial Asara size color etc CITY WELL LOCATION STATE ZIP <br /> Address Z80 Fast 6th Street <br /> City Tracy <br /> County San jo!aquin <br /> APN Boole Page Parcel <br /> or 2 7 <br /> Township��Range _Section <br /> or <br /> ` LatitudeDEG I MIN I SEC NORTH Longitude DEG MIN SEC WEST <br /> LOCATION SKETCH ACTIVITY (.!L)— <br /> r n NORTH _X NEW WELL <br /> i S Attached MODIFICATION/REPAIR <br /> Well Construction Lo —Deepen <br /> 1 <br /> i _Other(Specify) <br /> See Attached Site Map <br /> DESTROY(Describe <br /> i Procedures and Materials <br /> under GEOLOGfCLOG) <br /> N N PLANNED USES) <br /> to MONITORING <br /> WATER SUPPLY <br /> i r <br /> _ Domestic <br /> _ <br /> Public <br /> Irrigation <br /> i r <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 nq (irTc_Mnn7_tC) <br /> PLEASE BE ACCURATE Lr COMPLETE G - - <br /> illij P-0111t <br /> DRILLING <br /> METHOD Dl rP(`t Pilch FLUID <br /> WATER LEVEL & I IELD OF COMPLETED WELL <br /> DEPTH OF STATIC <br /> WATER LEVEL NIA (Ft) & DATE MEASURED <br /> ESTIMATED YIELD* (GPM) & TEST TYPE <br /> TOTAL DEPTH OF BORING 9 (Feet) TEST LENGTH (Hrs) TOTAL DRAWDOWN (Ft) <br /> TOTAL DEPTH OF COMPLETED WELL -- (Feet) ' May not be Tepresenlattve 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 /> DIA x c a MATERIAL/ CE BEN <br /> (Inches) o" a GRADE DIAMETER OR WALL IF ANY MENT TONITE FILL FILTER PACK <br /> Ft to Ft h ca o (Inches) THICKNESS (Inches) Ft to Fi (TYPE a SIZE) <br /> i <br /> 2-112 <br /> 'ATTACHMENTS (:) CFRTIFICATION STATEMENT <br /> 1 the undersigned certify that this report Is complete and accurate to the best of my knowledge and belief <br /> Geologic Log <br /> C <br /> .p. Well Construction Diagram NAME Camilla K. Williams, Terranext <br /> (PERSON FIRM OR CORPORATION) (TYPED OR PRINTED) <br /> Geophysical Log(s).� Geoph sicalLter g(s)Chemical Analyses 9838 Old Placerville Road, Suite 100; Sacramento , CA 95827 <br /> Soil/ ADDRESS • - CITYSTATE ZIP <br /> Other C z to Man �� <br /> ATTACH ADDITIONAL INFORMATION IF IT EXISTS WELL <br /> WELL DRILLER ADTHDRQED REPRESENTATIVE DATE SIGN D C 57 LICENSE NUMBER � <br /> DWR IRB RFV 740 IF ADDITIONAL SPACE IS NEEDED USE NEXT CONSECUTIVELY NUMBERED FORM n <br /> �3 I <br />