Laserfiche WebLink
VNIUINAL STATE OF CALIFORNIA Y - 120 N91-F. I N <br /> File rtrlth DWS WELL COMPLETION REPORT 4 <br /> Page 1 of Refer to Inrtrucrro>r Pamphlet STATE WELL NO tSTATION NO <br /> Owner's Well ND SG-19 NoG+ �} r� El <br /> Date Work Began Ended 9/25195 U O G LATITUDE LONGITUDE <br /> Local Permit AgencN ,San Joaquin County 2J1blic Health Services <br /> Permit No 10404 Permit Date P ' <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION (✓) VERTICAL _____ HORIZONTAL ANGLE (SPECIFY) Dame ';Dllf'bprn Pacific Iransportation Company <br /> DEPTH FROM DEPTH TO FIRST WATER M A (Ft) BELOW SURFACE Mailing Address <br /> SDRFACE DESCRIPTION <br /> Ft to Ft Describe rttaterial grain Size Color etc cin TE <br /> WELL LOCATION <br /> Address 780 East 6th Street <br /> City Tracy <br /> Count-, San �paquin <br /> See Attached APN Boot. Page Parcel <br /> Well Construction Log Township 2` Range 5I Section 2Z <br /> or <br /> Latitude „I NORTH Longitude I I WEST <br /> r DEG MIN SEC DEG MIN SEC <br /> LOCATION SKETCH ACTIVITY (✓} <br /> yy <br /> r NORTH _d NEW WELL <br /> r <br /> MODIFICATION/REPAIR <br /> ' __._Deepen <br /> i <br /> —Other(Specify) <br /> See Attached <br /> Site flap —DESTROY{Dasenbe <br /> Procedures end Mererrats <br /> Under GEOLOGICLOG ) <br /> P.- PLANNED USE(S) <br /> 3 W (�} <br /> MONITORING <br /> ' WATER SUPPLY <br /> Domestic <br /> Public <br /> 1 , <br /> ' T Irrigation <br /> - Industrial <br /> TEST WELL <br /> CATHODIC PROTEC <br /> SOUTH �y/ TION <br /> r Illustrate or Describe Distance of Well from Landmarks A_ OTHER(Specify) <br /> such as Roads Buildings Fences Rivers etc Soil Gas <br /> Mon- <br /> PLEASE BE ACCURA:E ry COMPLETE <br /> DRILLING Di rect Push <br /> METHOD FLUID <br /> WATER LEVEL & YIELD OF COMPLETED WELL <br /> DEPTH OF STATIC ��f1 <br /> WATER LEVEL lY A (Ft) & DATE MEASURED <br /> ESTIMATED YIELD` (GPM) & TEST TYPE <br /> TOTAL DEPTH OF BORING 2'5 (Feet TEST LENGTH (Hrs) TOTAL DRAWDOWN (FI) <br /> TOTAL DEPTH OF COMPLETED WELL 9• (Feet) 'May not he reprerentarive of a well's long-term yield <br /> DEPTH BORE CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE HOLE TYPE FROM SURFACE TYPE <br /> DIA z x a MATERIAL/ FDIA <br /> ERNAL GAUGE SLOT SIZE CE BEN <br /> (Inches) oc�Qi J GRADE METEROR WALL IF ANYMENT TONETE FILL FILTER PACK <br /> Ft to Ft nches) THICKNESS (Inches) Ft to Ft (TYPElSIZE) <br /> 0 ' 5.5 2-3/8 X PVC 1 chedule 40 0 3.5 ( X) (✓ ) {✓ ) <br /> .5 2-3/8 X PVC 1 3chedule 40 0.01 3.5 4.5 X <br /> 4.5 9.5 1 oneslar <br /> 2-. 112 <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 /> -X- Well Construction DiagramNAME Camalla K. Williams, Terranext <br /> Geophysical Log(s) (PERSON FIRM OR CORPORATION) (TYPED OR PRINTED) <br /> SodtWaterChemical Analyses 9838 Old Placerville Road, Suite 100; Sacramento, CA 95827 <br /> ADDRESS CITY STATE ZIP <br /> Other , �`C� `� 9 <br /> ATTACH ADDITIONAL fNFQRMATION fF fT EXISTS Sig ed <br /> WELL DRILLER AUTHORIZED REPRESENTATIVE DATE SIGNEII C57 LICENSE NUMBER <br /> DWR IRR RLt 7{MI IF ADDITIONAL SPACE IS NEEDED USE NEXT CONSECUTIVELY NUMBERED FORM <br />