Laserfiche WebLink
The free Adobe Reader may be used to view and coml fo ll. However,software must be purchased to complete,so <br /> nd reuse a saved form. <br /> File Original with DWR State Df California DWR Use Only-Do Not Fill In <br /> 3'Vell Completion Report i I <br /> r <br /> Page 1 Of 1 Refer to Inatruction Pamphlet I � I <br /> State Well Number/Site Number <br /> Owner's Well Number VW-3 _ No. e0240989 -7 <br /> Began 10/30/2014 Date"Jo k ded 10/30/21014 L__.I._T 1_- <br /> Date Work Be <br /> gLatitude Longitude <br /> Local Permit Agency San Joaauin County Envirotlm tttL.J Health Department <br /> Permit Number 0070825 Permit Da r• 1C 10/14 APN/TRS/Other <br /> _Geologic Log Well Owner <br /> Orientation (SiVertical 0Horizontal ;)/.nc a Specify_ Name Jim Weber <br /> Drilling Method Hollow Stem Auger Dri lin 7 Fluid <br /> Mailing Address 2229 Manzanita Court <br /> Depth from Surface Desctip io Lodi CA 95242 <br /> Feet to Feet Describe material,!Irai i s; color,etc Cit State—Zi <br /> 45 0 Drill Sample Install Well Location <br /> 2" Diameter Wells using U` I•lo I:Iw Stem Auger Address 230 N Church St <br /> See well materials used l:,ek w City Lodi County San Joaquin <br /> —.. Latitude N Longitude _yy <br /> Deo. Min Sec. Deq. Min. Sec. <br /> -- Datum Dec. Lat. 38.13772 Dec. Long.-121.27468 <br /> APN Book 043 Page 023 Parcel 01 <br /> Township —Range Section <br /> Location Sketch Activity <br /> --— Sketch must be drawn by hand after form isprinted.) Oi New Well <br /> --. North t0 Modification/Repair <br /> ---. O Deepen <br /> O Other <br /> 0 Destroy <br /> .——.. Describe procedures and materials <br /> under'GEOLOGIC LOG" <br /> -- Planned Uses <br /> 0 Water Supply <br /> -- <br /> [-]Domestic ❑Public <br /> --- u El irrigation [:1 industrial <br /> -- 0 Cathodic Protection <br /> -- 0 Dewatering <br /> ---. 0 Heat Exchange <br /> 0 Injection <br /> 0 Monitoring <br /> 0 Remediation <br /> -- 0 Sparging <br /> South 0 Test Well <br /> Illustrate or describe distance of well from roads,buildings,fences. O Vapor Extraction <br /> —_ rivers,etc and attach a map. Use additional paper d necessary. 0 Other <br /> Please be accurate and complete <br /> -- Water Level and Yield of Completed Well <br /> -- Depth to first water (Feet below surface) <br /> -- Depth to Static <br /> Water Level (Feet) Date Measured <br /> Total Depth of Boring 45 __ _ Feet Estimated Yield" (GPM) Test Type <br /> Total Depth of Completed Well 45 __ _ Feet Test Length (Hours) Total Drawdown (Feet) <br /> _ <br /> 'May not be representative of a well's long term yield. <br /> Casin;Is _ Annular Material <br /> Depth from Borehole Wall Outride Screen Slot Size Depth from <br /> Surface Diameter Type Materia rhickness Diameter Type if Any Surface Fill Description <br /> Feet to Feet Inches Inches Incies Inches Feet to Feet <br /> 45 15 8 Screen PVC Soh.40 __ 2 Milled Slots 0.030 45 13 Filter Pack #3 sand <br /> 15 0 8 Blank 2 13 11 Bentonite chips <br /> 11 0 Cement Portland 1/11 <br /> Attachments __ Certification Statement <br /> ❑ Geologic Log I, :hf u 7 iersigned,cert fy that this report is complete and accurate to the best of my knowledge and belief <br /> ❑ Well Construction Diagram r`;Irre ;!JI Well Abandonment, Inc. <br /> Person,Firm or Corporation <br /> ❑ Geophysical Log(s) 33 39 itzgerald Ro:id, Suite B Rancho Cordova CA 95742 <br /> ❑ Soil/Water Chemical Analyses Addrestl l :•~" �,, City state zip <br /> ❑ Other Site Map s ]nod —r 11/11/2014 848359 <br /> Attach additional information,?f it exists. �. -57��IatpwMlell oncraaor Date Signed C-57 License Number <br /> DWR 188 REV 112006 IF ADI IIT;;VAL SPAC�.1S NEEDED.USE NEXT CONSECUTIVELY NUMBERED FORM <br />