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ORICEI♦,NAL STATE OP (AI IFORNIA W R N Y — N T F I L i N <br /> File with DWR WELL COMPLETION REPORT <br /> Page I STATE WELL NO ISTA N NO <br /> Pa C OF Refer to Instruction Pampblee f^ <br /> Owner's'1�1'ell No SG-17 NO 4, 6 8 `J 8 � LATITUDE ❑ LONG4TUDE ❑ <br /> 15ate Work Began 9125/96 Ended .—9/25/96 <br /> Local Permit Agene) San Joaquin County Public Health Services <br /> Permit No 10404 Permit Date APNITRSIDTNER <br /> ---_-- <br /> �t GEOLOGIC LOG WELL OWNER <br /> ORIENTATION (2L X VERTICAL _ HORIZONTAL _ ANGLE „ (SPECIFY) Name Southern d i Fr1 <br /> DEPTH TO FIRST WATER A (Ft) BELOW SURFACE Mailing Address One Market Plaza <br /> DEPTH FROM <br /> SURFACE DESCRIPTION San Fran <br /> Ft to Ft Describe rrw(erial,grain size color, erc CITY STATE ZIP <br /> WELL LOCATION <br /> Address 780 East 6th Strept <br /> City <br /> County _ San, Joaaui n <br /> APN Book. Page Parcel <br /> Township -n- Range 5E Section 27 <br /> See Attached or <br /> Latitude I I NORTH Longitude----- <br /> DEG MEN SEC DEG MN SEC <br /> Well CQnstruction 1-0 a LOCATION SKETCH ACTIVITY {�) <br /> ' NORTH _X_ NEW WELL <br /> ' MODIFICATION/REPAIR <br /> r i <br /> i <br /> Deepen <br /> —Other(Speclty) <br /> See Attached Site Map <br /> DESTROY(Describe <br /> Procedures and AMafenars <br /> ' Under GEOLOGICLOG) <br /> y PLANNED USES) <br /> w <br /> LU MONITORING <br /> i <br /> ' WATER SUPPLY <br /> r <br /> Domestic <br /> i t <br /> Public <br /> Irrigation <br /> ' Industrial <br /> TEST WELL <br /> SOUTH <br /> __._ CATHODIC PROTEC <br /> TION <br /> Ilfustrafe or Describe Chstance of Well from Landmarks OTHER(Specify) <br /> such as Roads Buildings Fences Rivers etc A7 1 CirZS Mani to <br /> PLEASE' BE ACCURAy E 6 COMPLETE <br /> DRILLING Direct Push <br /> METHOD FLUID <br /> WATER LEVEL & YIELD OF COMPLETED WELL <br /> DEPTH OF STATIC <br /> na <br /> WATER LEVEL (Ft) & DATE MEASURED <br /> ESTIMATED YIELD' (GPM) & TEST TYPE <br /> TOTAL DEPTH OF BORING (Feet) TEST LENGTH (Hrs) TOTAL DRAWDOWN (Ft) <br /> TOTAL DEPTH OF COMPLETED WELL 9 ,.._ (Feet) *May not be representanve of a well s long-term yield <br /> DEPTH CASINGS) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE BORE WE ._!'!� FROM SURFACE TYPE <br /> HOLE <br /> EMAMETER <br /> GAUGE SLOT SIZE <br /> DIA MATERIAL! CE BEN <br /> (inches) GRADE OR WALL IF ANY MENT TONITE FILLFILTER PACK <br /> Ft to Ft THICKNESS (inches) Ft to Ft (TYPE/SIZE) <br /> D 5 - X <br /> r <br /> ATTACHMENTS (!) CERTIFICATION STATEMENT <br /> Geologic Log t the undersigned certify that this report IS Complete and accurate to the best of my knowledge and belief <br /> _ <br /> C <br /> Well Construction Diagram NAME Camilla K. Williams, Terranext <br /> GeophysicalLog(s) (PERSON FIRM OR CORPORATION) (TYPED OR PRINTED) <br /> SWUWeterChemical Analyses 9838 Old Placerville Road, Suite 100; Sacramento; CA 95827 <br /> � <br /> S7tP_ Map ADDRESS y� a CITY STATE Z1P other_ k- <br /> ATTACH ADDITIONAL INFORMATION IF IT EXISTS Signed GATE SIGNE C 57 LICENS[ $t)MBER <br /> WELL DRILLER Al1THORIZED REPRESENTRTNE <br /> DWR 1811 RSV 7 90 IF ADDITIONAL SPACE IS NEEDED USE NEXT CONSECUTIVELY NUMBERED FORM <br />