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ORIGI�!AL STATI[ Of- CALIFORNIA w NLY — N T I I <br /> ;rtlb`with DWR WELL COMPLETION REPORT r <br /> Page Of Refer to Inrtructron Pamphlet STATE WELL NO IS ATOM NO <br /> Owner's Well No SVE_Z No4 3 7 2 6 4 LATITUDE ElDate Work Began.,.,._ 924/96 Ended 9/24/96 LONGITUDE <br /> Local Permit Agency San-Joaquin County Public Health Services <br /> dbPermit No 5399 Permit Date 2/24/95 1- APNIISS/OnIER <br /> GEOLOGIC LOG WLLL OWNER <br /> ORIENTATION (.:f 1— VERTICAL _ HORIZONTAL _ANGLE — (SPECIFY) Name Southern Pacific Trans ortatl fan CompM <br /> DEPTH TO FIRST WATERN/A (FL) BELOW SURFACE Mailing Address One Market P <br /> DEPTH FROMSan rCA 94105— <br /> SURFACE DESCRI PTION Gtr <br /> ancisco <br /> Ft to Ft I)etcn � tm WELL LOCATION <br /> be mxerml atrre talon etc STATE XIP <br /> Address 780 East, fith Street <br /> City Tracy <br /> County San JOaQlJin � <br /> See Attached APN Boot. Page Parcel <br /> Well Construction Log Township 2S—RangeSE Section 27 <br /> or <br /> 1 Latitude DEG MIN SEC NORTH Longitude 1 1 WEST <br /> DEG MIN SEC <br /> LOCATION SKETCH ACTIVITY (—' ) <br /> 1 NORTH X_ NEW WELL <br /> ' MODIFICATION tREPAIR <br /> _Deepen <br /> 1 � <br /> 1 1 -Other(Specify) <br /> See Attached Site Map <br /> DESTROY(Describe <br /> Procedures and Mstene)s <br /> Under GEOLOGiCLOG) <br /> PLANNED USE(S) <br /> w (✓) <br /> LU <br /> _ MONITORING <br /> WATER SUPPLY <br /> Domestic <br /> _ <br /> Public <br /> Irrigation <br /> 1 i industrial <br /> TEST WELL <br /> CATHODIC PROTEC <br /> SOUTH '!ON <br /> Illustrate or Describe Distance of Well from Landmarks OTHER(Specify) <br /> such as Roads Buildings Fences Revers etc Ut4I)nr <br /> PLEASE BE ACCURATE & COMPLETE i p <br /> DRILLING <br /> METHOD FLUID <br /> WATER LEVEL & YIELD OF COMPLETED WELL <br /> DEPTH OF STATIC <br /> WATER LEVEL (Ft) & DATE MEASURED <br /> ESTIMATED YIELD (GPM) & TEST TYPE <br /> TOTAL DEPTH OF BORING C)-5 - (Feet) TEST LENGTH (Hrs) TOTAL DRAWDOWN (Ft) <br /> TOTAL DEPTH OF COMPLETED WELL (Feet) 'May not be representative Of a well's long-term yield <br /> DEPTH CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE BORE TYPE `1 FROM SURFACE TYPE <br /> HIDE = z INTERNAL GAUGE SLOT SIZE CE BEN <br /> MATERIAL t <br /> (inches) W =o a DIAMETER OR WALL IF ANY FILTER PACK <br /> MEN TONITE FILL <br /> 1 t to Ft m y �� J GRADE (Inches) THICKNESS (inches) Ft to Ft <br /> (Z-) ( , ) (� ) (TYPE/SIZE) <br /> 1 ' <br /> 9.5 10 PVC 4 Schedule 5 ' 4.5 X <br /> r <br /> 1 � <br /> 2 <br /> ATTACIIMENTS (✓) CERTIFICATION STATEMENT <br /> I the undersigned certify that this rep`oli Is complete and accurate to the best of my knowledge and belief <br /> V_ <br /> Geologic Log <br /> p_ Wa11ConatruCitonDiagram NAME Camilla K. Williams, Terranext <br /> (PERSON FIRM OR CORPORATION) (TYPED OR PRINTED) <br /> Geophysical Log(s) CA 95827 <br /> _ soel/weterChemlcelAnayaea 9838 Old Placervx.11e Road,_.Suite lOO;Sacramento, <br /> CITY �T�E ZIP <br /> ADORE � � � <br /> X._. Other Site Man AIR <br /> ATTACH ADDITIONAL INFORMATION IF IT EXISTS toned 4L <br /> WELL pRILLER AUTHORIZED REPRESENTATIVE DATE SIGN C57 LICENSE NUMBER <br /> DWR1Rttlit N 7$90 IF ADDITIONAL SPACE IS NEEDED USE NEXT CONSECUTIVELY NUMBERED FORMA i3 <br />