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0,81GINAL STATE Or (AI IT ORNIA WR R u ,�N Y — F t 1 <br /> File with DWR WELL COMPLETION REPORT <br /> Pagel of �z Refer to lnitructron Pamphlet STATE WELL NO 11 NO <br /> Owner's Well No SG-06 req yNo 3 7 2 6 8 ❑ <br /> 9/24/96 9/24/95 LATITUDE LONGITUDE <br /> Date Wori, Began Ended <br /> Local Permit Agency San Joaquin Count Pub ii Health Services F, 11 1 1 1 1 1 1 AMPermit Ivo 10404 Permit Date 9/12/96 R <br /> GEOLOGIC LOC W ELL, OWNER <br /> ORIENTATION (.::L) " VERTICAL _ HORIZONTAL _ ANGLE _ (SPECIFY) dame Southern Pacific Transportation Com an <br /> DEPTH TO FIRST WATER A (Ft) BELOW SURFACE MathAddress One Market Plaza <br /> 6 SURFACE Sia <br /> DESCRIPTIO)v n Francisco CA 94105 <br /> SURFACE <br /> CITY STATE ZIP <br /> Ft to Ft Describe materna! ant size color etc <br /> WELL LOCATION <br /> Address 780 East 6th Street <br /> City Trac <br /> County San-Joaquin <br /> APN Boot. Page Parcel <br /> See Attached Township 2S Range 5E Section 27 <br /> Well Construction Log Latitude NORTH Longitude i WEST <br /> i DEG MLN SEC DEG MIN SEC <br /> LOCATINONRnSKETCH �NCTI EW ELTY (� 1 <br /> MODIFICATION/REPAIR <br /> Deepen <br /> —Other(Specify) <br /> DESTROY(Describe <br /> Procedures and Materials <br /> See Attached Site Map Einder GEOLOGICLOG) <br /> I— PLANNED USES) <br /> N <br /> ' ' W MONITORING <br /> i WATER SUPPLY <br /> _ Domestic <br /> Public <br /> Irrigation <br /> i <br /> Industrial <br /> TEST WELL <br /> CATHODIC PROTEC <br /> SOUTH TION <br /> Illustrate or Describe Dtstance of Well from Landmarks OTHER(Specify) <br /> such as Roads Buildings Fences Rivers etc soil Ca S Mnn 1 t <br /> PLEASE BE ACCURATF & COMPLErF <br /> !Fly Pullit <br /> DRILLING <br /> METHOD—,_Q1 reCt PLISh _ __FLUID <br /> WATER LEVEL A YIELD OF COMPLETED WELL <br /> DEPTH OF STATIC <br /> WATER LEVEL NIA (Ft) a DATE MEASURED <br /> ESTIMATED YIELD (GPM) & TEST TYPE <br /> TOTAL DEPTH OF BORING 9.5 (Feet) TEST LENGTH (Hrs) TOTAL DRAWDOWN (Ft) <br /> TOTAL DEPTH OF CONIPLETED WELL—9-5— (Feet) 'May not be representative of a well's long-term yield <br /> DEPTH CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACEBORE TYPE FROM SURFACE TYPE <br /> HOLE INTERNAL GAUGE SLOT SIZE <br /> DIA z a MATERIAL! DIAMETER OR WALL IF ANY CE BEN FILTER PACK <br /> (inches) W z aMENT TONITE FILL <br /> Ft to Ft m y �� _ GRADE (TYPE SIZE) <br /> (Inches) THICKNESS (Inches) Ft to Ft <br /> i <br /> LL <br /> ATTA('11MENTS 0 ! CERTIFICATION STATEMENT <br /> .,..^ Geologic Log I the undersigned certity that this report is complete and accurate to the best of my knowledge and beflet <br /> Well Construction Diagram NAME Camilla K. Williams Terranext <br /> (PERSON FIRM OR CORPORATION) (TYPED OR PRINTED) <br /> Geophysical Log(s) <br /> �. SOIIIWater Chemical Analyses 9838 Old Placerville Road Suite 100• Sacramento, CA 95827 <br /> Other cc 1�� Map ADDRESS CITY IL ZIP <br /> . d <br /> ATTACH ADDITIONAL INFORMATION IF 1T EXISTS Signed , OATE SIGNED C 57 L[GENSE NUMBER <br /> WELL DRILLER AUTHORIZED REPRESENTRnVE <br /> DWR IMRLV 7,90 IF ADDITIONAL SPACE IS NEEDED, USE NEXT CONSECUTIVELY NUMBERED FORM { '1 <br />