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ORIGINAL I \I L 01h C 1L11 ()H\t\ DWR USE ONLY — 00 NOT FILL 7N <br /> S <br /> ;.lie with DWR WELL COMPLETION REPORT 4 <br /> 1 1{,fr+ to latjrie'um P+lin(11+1rt STATE WELL NU'STATION NO <br /> tyttticI's Vv ell No No 15 4 0 � O <br /> � ,r LATITUQE LONGITUDE <br /> Date \ 1311, 13r,,in Ended <br /> Sin TnRclljjn f'QtT t-v PiThl , r- Waw l + h <br /> APNlTRS,OFHER <br /> Pei tint \4626237 Pel nilt D tte-d-1 -01 <br /> GIV ELL OWNER <br /> GEOLOGIC LOG <br /> ORIENTATION (L) X VERTICAL —HORIZONTAL —ANGLE —(SPECIFY) N tine <br /> DRILLING Nvldlling -kddiess <br /> DEPTH FROM METHOD FLUID <br /> SURFACE DESCRIPTION Concord CA 94520 <br /> CIT`! STATE Z9Ft to Ft Dr.+(+the Nlntf i ial ,'I(III? ,tic culur c tc. WELL LOC-1TION <br /> -Wch ess 16 0 5 <br /> c1tv Stockton <br /> Coullty San Joaquin <br /> I i API Book1 6 7 Page 31 Palcel 01 <br /> ToNviishlp Range Section <br /> i I Latlt-tide INORTH Loffigitude <br /> DEG MIN SEC WEST <br /> DEG MIN SEC <br /> LOCILTION SKETCH kCTIAIITY (-;L) <br /> i NORTH NEW WELL <br /> i I See attached Site plan. MODIFICATIONtREPA1R <br /> — Deepen <br /> I I — Other(Specify) <br /> s 1 <br /> v i DESTROY(Gescrrbe <br /> Procedures and Materials <br /> I Under GEOLOGIC LOG J <br /> PLANNED USES (-�L) <br /> WATER SUPPLY <br /> Domestic - Puollc <br /> I– w <br /> Irrigation — Industrial <br /> W W MONITORING— <br /> TEST WELL— <br /> ' CATHODIC PROTECTION <br /> HEAT EXCHANGE <br /> DIRECT PUSH— <br /> i INJECTION— <br /> VAPOR EXTRACTION — <br /> i <br /> SPARGING— <br /> ' ' SOUTH REMEDIATION <br /> i !llumatc orDcscnb, DistancL rf S1 allfivili Roads Blildfn,,+ <br /> FLIItLs Ric,M etc tnlel ritt0th a pari USL WhIlt,u11rr1 ff,allu if OTHER{SPECIFY) _ <br /> ucccstn+y PLE-ISE BE ACCtJHA�E&CObIPL.ETE <br /> WATER LEVEL & YIELD OF COMPLETED WELL <br /> DEPTH TO FIRST WATER (Ft) BELOW SURFACE <br /> I i <br /> ' DEPTH OF STATIC Ft &DATE MEASURED <br /> WATER LEVEL ( ) <br /> ' �-^ ESTIMATED YIELD (GPM) & TEST TYPE - <br /> roT 1L I)EP'11 t l)H 13011(\C ---- eetl TEST LENGTH (Hrs) TOTAL DRAWDOWN (Ft) <br /> 1OTIL DEPT ti OF ( OMPI ET£.D 11 CLL lreetl ° Ifin,not be leplejeIIrurtt.e of a a e1l3 1otarqf-teiwr yield <br /> DEPTH CisING (S) DEPTH a\NULAR N1 4T1 RILL <br /> FROM SURFACE BORE TYPE(_) FROM SURFACE TYPE <br /> HOLE ✓ INTERNAL GAUGE SLOT SIZE CE BEN <br /> DIA w a a MATEPiAL FILTER PACK <br /> (Inches) GRADE: DIAMETER OR WALL IF ANY Ft to Ft MENT TONITE FILL (TYPE)SIZE) <br /> Ft ro Ft m N LL (Inches} THICKNESS s(Inches) {✓) {!) (�) <br /> L j -PQv i <br /> i <br /> 4fT4('[l�lC`TS (�1 CI;RTIFICkTION STYTE\IE\'T <br /> I the undersigned certify that this report Is complete and accurate to the best of my knowledge and belief <br /> Geologic Log <br /> _ Well Construction Diagram NAME 111� <br /> (PERSON FIRM OR CDRPORATION) [HYPED R PvmtDI <br /> Geophvsical Log(s) 120 -ROX 95641 <br /> Sall/Water Chem[col AnalysesAppRESS ['ITV STATE -1P <br /> b Other f 6 ~r <br /> A7T ICr1 dDD1TlONAL /NFORN1AT10 IF fr EXISTS 5+4ned ��' ~� pAT� SIGNEp� T� C 5l LICy yC�t$ER^ <br /> RlAl1T8ORIZFD E ESENTATPoE <br /> uI Ititi Itl+ It + IF ADDITIONAL SPACE IS DEEDED USE NEXT CONSECUTIVELY NUMBERED FORM <br />