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ORIGINAL STATE OP (ALIT ORNIA N T FIL I <br /> File with DWR WELL COMPLETION REPORT f' <br /> Refer to Insirurriorr Pampbler $TATE wELI r AIF NO ❑ <br /> Page__L_of�_ ❑ <br /> Owner's Well No AS-1 No 437265 <br /> LATITUDE LONGITUDE <br /> III I <br /> Date Work Began�9/24/96 Ended 9/24/96 <br /> Local Permit Agencv San Joaquin County Rubl ic_ Health Services <br /> Permit No 5399 Permit Date <br /> 2/24/96APN1TRS/RTtjER <br /> GEOLOGIC LOG w ELL OWNER <br /> ORIENTATION (i) VERTICAL _ HORIZONTAL _ ANGLE _(SPECIFY) Name Southern Pacific Trangl2artation Company <br /> DEPTH FROM <br /> DEPTH TO FIRST WATER 18 (Ft) BELOW SURFACE Mailing Address One Market Plaza <br /> SURFACE DESCRIPTIONSan- Francisco <br /> Ft to Ft Describe material gTarn size,color,etc CITY STATE ZIP <br /> WELL LOCATION <br /> Address 780 East 6th Street <br /> City <br /> Tracy- <br /> county an Joaquin <br /> APN Book Page Parcel <br /> Attached Wgll Construction Township 2S ___Range 5E Section _27 — <br /> or <br /> Latitude v NORTH Longitude i WEST <br /> i DEG MIN SEC DEG MIN SEG <br /> LOCATION SKETCH ACTIVITY (�) <br /> NORTH NEW WELL <br /> MODIFICATION/REPAIR <br /> a <br /> Deepen <br /> ' Other(Specify) <br /> r <br /> See Attached Site Map _DESTROY(Descnbe <br /> i Proeedares and Materials <br /> Under GEOLOCICLOG ) <br /> r PLANNED USE(S) <br /> rnLil <br /> w ✓ <br /> L MONITORING <br /> ' WATER SUPPLY <br /> ._.,., <br /> Domestic <br /> Public <br /> Irrigation <br /> �.._._ Industrial <br /> TEST WELL <br /> — CATHODIC PROTEC <br /> i r SOUTH TION <br /> Illustrate or Describe Distance of Well from Landmarks OTHER(Specity) <br /> such as Roads Buildings Fences Racers etc Air 5 a r <br /> PLEASE BE ACCURATE dr COMPLETE ��—QP <br /> DRILLING <br /> METHOD {-Ind low StPm A1JgP_r__ FLUID <br /> WATER LEVEL & YIELD OF COMPLETED WELL <br /> DEPTH OF STATIC <br /> WATER LEVEL _ ,I r�pp <br /> te—(Ft) & DATE MEASURED 9.129.196 <br /> ESTIMATED YIELD' (GPM) & TEST TYPE <br /> TOTAL DEPTH OF BORING (Feet) TEST LENGTH (Hrs) TOTAL DRAWDOWN (FI) <br /> TOTAL DEPTH OF COMPLETED WELL---22- (Feet) '"May not be representative of a well's long-term yield <br /> DEPTH CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE FROM TYPE ✓ FROM SURFACE TYPE <br /> HOLE — INTERNAL GAUGE SLOT SIZE <br /> DIA z � d MATER(ALJ CE I BEN <br /> (Inches) row a GRADE DIAMETER OR WALL IF ANY MENT TONITE FILL FILTER PACK <br /> Fi to Ft c�� = Onehas) THICKNESS (Inches) Ft to Ft (TYPE SIZE) <br /> 0!) 0L) (�) <br /> a 19.5 8x PVC 1 Schedule 40 0 15 x <br /> r , <br /> ATTACHMENTS (!) CERTIFICATION STATEMENT <br /> V— Geologic Loo I the undersigned certify that thl�report is complete and accurate to the best of my knowledge and belief <br /> 6— Well Construction Diagram NAME Camilla K. Williams, Terranext <br /> (PERSON FIRM OR CORPORATION) (TYPED OR PRINTED) <br /> Geophysical Log(s) <br /> Sodtwater Chemical Analyses 9838 01d Placerville Road, Suite 100. Sacramento: CA 95827 <br /> ADDRE 5 _ CITY STALE XIP <br /> X— Other Si`e Map <br /> ATTACH ADDITIONAL INF'oRMATION IF IT EXISTS Signe J✓//o - --'--— <br /> WELL DRILLER AUIMMIZED REPRESENTATIVE DATE SIGNE <br /> C57 LICENSE NUMB{g <br /> DWR 1814 REV 790 IF ADDJTIONAL SPACE IS NEEDED, USE NEXT CONSECUTIVELY NUMBERE FORM <br /> 13 <br />