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ORIGINAL STATE OF CALIFORNIA QWIRY — N T Ft I <br /> File with DWR WELL COMPLETION REPORT S 0 (_ L" d <br /> Page 1 of_I— Refer to Irrsiructiorr Pamphlet STATE WELL No(STATION NO <br /> Owner's Well No PZ-10 No <br /> 437266 11 <br /> Date Wort. Began 9/23/95 Ended 9 23196 <br /> twTITUDE LONGITUDE <br /> Local Permit Agency San Joa ui n County Eublic Health Services <br /> P r r <br /> Permit No 5399 Permit Date - 2124195 <br /> MER <br /> GEOLOGIC LOG WELL O%NER <br /> ORIENTATION (!} VERTICAL — HORIZONTAL — ANGLE —(SPECIFY) Name <br /> DEPTH TO FTRST WATER9.5 (FL) BELOW SURFACE Mailing Address <br /> onP Market Plan <br /> DEPTH FROM <br /> SURFACE DESCRIPTION <br /> San Franrisro CA 94.10.5— <br /> Ft 10 Ft Describe material, ant size color etc CITY STATE ZIP <br /> Rr WELL LOCATION <br /> Address <br /> City Tracy <br /> count —San Joaquin <br /> $ee Attached Well Unstruction LO APN Book Page Parcel <br /> or r2 7 <br /> Township� Range�.^Section <br /> f atitude NORTH Longitude WEST <br /> DEG MIN SEC DEG MIN SEC <br /> — LOCATIONSKETCHACTIVITY ELL <br /> NO aL- (✓ ? <br /> ' MODIFICATION/REPAIR <br /> + <br /> Deepen <br /> ' T Other(Specify) <br /> See Attached Site Map <br /> DESTROY(Descrebe <br /> i Procedures and Materials <br /> under GEOLOGICLOG 1 <br /> PLANNED USE(S) <br /> W Lu X (�) <br /> MONITORING <br /> WATER SUPPLY <br /> � Domestic <br /> _ <br /> Public <br /> Irrigation <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 <br /> PLEASE BE ACCURATE. & COMPLETE <br /> DRILLING Hollow Stem Auger <br /> METHOD FLUID <br /> WATER LEVEL & YIELD OF COMPLETED WELL <br /> DEPTH OF STATIC 9.5 9/23/95 <br /> WATER LEVEL (Ft) 8 BATE MEASURED <br /> ESTIMATED YIELD (GPM) S TEST TYPE <br /> TOTAL DEPTH OF BORING 20 (Feet) TEST LENGTH (Hrs) TOTAL DRAWDOWN (FI) <br /> TOTAL DEPTH OF COMPLETED WELL . ren (Feet) May not be representative of a well's long-term yield <br /> DEPTH CASINGS) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE BORE TYPE ✓ FROM SURFACE TYPE <br /> HOLE — INTERNAL GAUGE SLOT SIZE <br /> DIA W a MATERIAL/ DIAMETER OR WALL IF ANY CE BEN FILTER PACK <br /> z x aMENT TONITE FILL <br /> {Inches) c <br /> Ft to Ft m H �o ]GRADE (Inches) THICKNESS (Inches) Ft t0 Ft (TYPE/SIZE) <br /> (') (°) (i' ) <br /> 0 5 8 X PVC 2 Schedule 10 0 2 X <br /> 5 20 8 1xi I PVC 2 Schedule 40 0.02 2 <br /> 20 — 1 Qne tar <br /> — 2-112 <br /> ATTACHMENTS CERTIFICATION STATEMENT <br /> I the undersigned certify that this report Is complete and accurate to the beat of my knowledge and belief <br /> Geologic Lou <br /> x <br /> Well ConstruclsonDiagram NAME Camilla K. Williams e <br /> Terranxt <br /> (PERSON FIRM OR CORPORATION) (TYPED DR PRINTED) <br /> .�. <br /> Geophysical Loy(a) <br /> SodIWater Chemical Analyses 9838 Old Placerville Road Suite 100• Sacramento CA 95827 <br /> L Other Site Maw __ ADDRESS CITY STATE ZIP <br /> ATTACH AODIPONA1. tNF0RMAT70N W IT EXISTS Signed TE SIGNEDC 57 LICENSE NUMBER <br /> WELL DRILLER AUTI(ORIZED PRESENTATIVE <br /> DWR ISS RFV 7 90 IF ADDITIONAL SPACE IS NEEDED USE NEXT CONSECUTIVELY NUMBERED FORM 1311 <br />