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ORIGINAL ST;\TE OF CALIFOKNIA W R QSE ONy — 00 NOT FILL IN <br /> File with DWR WELL COMPLETION REPOR <br /> Page_of nn Pampblet STATE WELL NO.I TATIOI ND. <br /> �� Refer to Inrtrctiu �t <br /> No. -07, 7 — ❑ <br /> Owner's Well No. -d '_ r <br /> Date Work Began S P n t - 1 7 - 1 9 9, Ended LATITUDE I LONGITUDE <br /> Local Permit agency U i n Co H e a l t h Dept . 7 I i A I I l Hr rRStOTHI _t_ R t I I <br /> Permit No. 93-1863 Permit Date <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION (!) VERTICAL — HORIZONTAL —ANGLE —(SPECIFY) )`lame Ben Boyd <br /> DEPTH TO FTRS"C WATER 2 0 (Ft.) BELOW SURFACE Mailing .address 3 2 5 W 12th S t . <br /> DEPTH FROM DESCRIPTION95376 <br /> SURFACE CITY Tracy tr a STATE ZIP <br /> Ft, to Ft. Describe material,•grain rise,color.etc. WELL LOCATION <br /> SQil Address 4911 Durham Ferry <br /> I a y City T r a <br /> 18 24 Sand County San Joaquin <br /> 24 85 ClaY APN Book? EZ Pag3� W Parcel <br /> ;8588 I Township � Range Section_Or <br /> 88 101 lay Latitude NORTH Longitude W= <br /> DEG. MIN. SEC. DEG. MIN. SEC. <br /> LOCATION SKETCH y ACTIVITY (! <br /> X <br /> NORTH NEW WELL <br /> MODIFICATION!REPAIR <br /> Deepen <br /> 1 68 1 73iGraypl —Other(Specih <br /> 171 ' 190 : Clay <br /> DESTROY(Describe <br /> Procedures and Mare <br /> Under'•GEOLOGIC L C <br /> PLANNED USE( <br /> Lu in <br /> 3 MONITORING <br /> WATER SUPPLY <br /> X� Domestic <br /> Public <br /> Irrigation <br /> Industrial <br /> "TEST WELL" <br /> _ CATHODIC PROT <br /> SOUTH TION <br /> Illustrate or Describe Distance of Well from Landmarks — OTHER(Specify) <br /> such as Roads,Buildings,Fences,Rivers,etc. <br /> PLEASE BE ACCURATE L COMPLETE. <br /> METHOD_u d Rotary FLUID Water/Benton i <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 19 0 (Feet) TEST LENGTH (Hrs.) TOTAL DRAWDOWN (FO <br /> TOTAL DEPTH OF COMPLETED WELL 1 7 7 (Feet) 'May not be representative of a well's long-terns yield. <br /> DEPTH CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE BORE• TTYPE FROM SURFACE TYPE <br /> HOLE — INTERNAL GAUGE SLOT SIZE <br /> DIA. MATERIAL/ CE- BEN•(Inches) c� <'- GRADE DIAMETER OR WALL IF ANY MENT TONITE FILLFILTER PACK <br /> Ft. to Ft. u� = (Inches) THICKNESS (Inches) Ft. to Ft. (TYPE!SIZE) <br /> 0 157 12 X PVC 641 160sch 0 105 X <br /> I1571 177 12 X PVC 6i1 160sch Screen <br /> f <br /> ATTACHMENTS (!) CERTIFICATION STATEMENT <br /> Geologic Lop I,the undersigned, certify that this report is complete and accurate to the best of my knowledge and belief. <br /> _ Well Construction Diagram NAME H E N N I N G S BROS . DRILLING CO. , INC . _�3 f <br /> (PERSON. FIRM. OR CORPORATION) (TYPED OR PRINTED) <br /> Geophysical3525 PELANDALE AVE. MODESTO CA 95356 <br /> Soilr WattererCChemhemiccal Analyses <br /> ADDRESS CA TY STATE tfP <br /> Other <br /> ATTACH ADDITIONAL INFORMATION. IF IT EXISTS. Signed I OCT.1 9,1993 290813 <br /> WELL DRILLER/AUTHORIZED REPRESENTArr DATE SIGNED C 57 LICENSE NUMSEF <br /> uwIt INK REV.T-tR1 IF ADDITIONAL SPACE IS NEEDED, USE NEXT CONSECUTIVELY NUM13ERED FORM <br />