Laserfiche WebLink
`rhe free Adobe Reader may be used to view and comp! s form. However,software must be purchased to complete,dand reuse a saved form. <br /> File Original with DWR State of California DWR Use Only-Do Not Fill In <br /> Well Completion Report <br /> Page of Refer to Ideftwaon Pamphlet State Well Number/Site Number <br /> Owners Well Number OBS-1 No. e0254713 <br /> Date Work Began 01/07/2015 Date Work Ended 1/8/2015 Latitude Lon itude <br /> Local Permit Agency San Joaauin county Environmental Health <br /> Permit Number 70983 Permit Date 11/18/14 APN/TRSrother <br /> Geologic Log Well Owner <br /> Orientation 0 Vertical O Horizontal OAngle Specify Name The Source Group <br /> Drilling Method Auger Drilling Fluid <br /> Depth from Surface Description Mailing Address 944 McCourtney Road Suite H <br /> Feet to Feet Describe material,grain size,color,etc city Grass Valley State CA Zip 95949 <br /> 0 40 Clay, dense,stiff, light brown Well Location <br /> 40 80 Clays,stiff,darker brown Address 10848 Cooper000lis Road <br /> 80 120 Semi-silty dense clay mix,stiff clay,dark brown City Stockton County San Joaquin <br /> Latitude N Longitude __ W <br /> Deo. Min. Sec. Dec. Min. Sec. <br /> Datum Dec.Lat. Dec.Long. <br /> APN Book Page Parcel <br /> Township -Range Section <br /> Location Sketch Activit <br /> Sketch must be dram by hand after form is pri (D New Well <br /> North <br /> O Modification/Repair <br /> O Deepen <br /> O Other <br /> - <br /> 0 Destroy <br /> analar-G OLOGImam memnals <br /> uMer GEOLOGIC LOG <br /> Planned Uses <br /> O Water Supply <br /> ❑Domestic E]Public <br /> an <br /> 3 w ❑Irrigation ❑Industrial <br /> O Cathodic Protection <br /> O Dewatering <br /> O Heat Exchange <br /> O Injection <br /> 0 Monitoring <br /> O Remediation <br /> O Spangling <br /> South O Test Well <br /> Ilwsnaeorawcne<aurz<e<er.<Il r,<m,<ee:,omul<s<,ren<ss. O Vapor Extraction <br /> aa,ae and.narnamap.Use aem,a�.,l a=ae,o�eeessa" OOther <br /> mease e<a<am,<zm comp!<,<. <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 120 Feet Estimated Yield (GPM) Test Type <br /> Total Depth of Completed Well 120 Feet Test Length (Hours) Total Drawdown (Feet) <br /> 'Ma not be representative of a well's long term yield. <br /> Casings Annular Material <br /> Depth from Borehole Wall Outside Screen Slot Size Depth from <br /> Surface Diameter Type Material Thickness Diameter Type if Any Surface Fill Description <br /> Feel to Feet Inches Inches Inches Inches Feet to Feet <br /> 0 80 8 Blank IPVC I SCh 40 12 1 1 0 75 Portland Cement <br /> 80 120 8 Screen Pvc Sch 40 2 Slot 0.010 75 78 Bentonite Chips <br /> 78 120 Sand 2/12 <br /> Attachments Certification Statement <br /> ❑ Geologic Log I,the undersigned,certify that this report is complete and accurate to the best of my knowledge and belief <br /> ❑ Well Construction Diagram Name Cascade Drillino. L.P. <br /> Person,Eion or Corporation <br /> ❑ Geophysical Log(s) 3000 Duluth Street West Sacramento CA 95691 <br /> ❑ SoilM/ater Chemical AnalysesAddrea city state Zip <br /> 17 Other Site Map Signed -lr 02/12/2015 938110 <br /> Attach additional information if it exists. C-9 License ager WeFContraccir Date Signed C-57 License Number <br /> DWR 188 REV.112006 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY LUMBERED FORM <br />