Laserfiche WebLink
I I , <br /> E � � <br /> `The free Adobe Reader may be used to view and com Dlete this form. However,software must be pu chased to,complete,save,and reuse a saved form. <br /> I <br /> File Original with DWR State of California I DM Use On -Do Not Finan <br /> I <br /> Well Completion Report <br /> Page 1 Of 1 Refer to rnslntoon Pamphlet I State Well Number/Site Number <br /> Owner's Well Number DP-2 No. @0239210 j N ( , t I I w <br /> Date Work Began 08/26/2014 I late Work Ended I Latitude Lon !lute <br /> Local Permit Agency I <br /> Permit Number SR#70283 I Perm t Date 8/11/14 I APNrrRS/Other <br /> Geologic Lo 3 Well Owner <br /> Orientation O Vertical O Horizontal OAngle Specify Nar ie G Miller Family Partnership <br /> Drilling Method Hollow Stem Alger I Drilling Fluid Mai ing Add�I ss P.O.BOX 336 <br /> Depth from Surface I ascription Tracy: State CA 7i 95378 <br /> Feet to Feet Describe mat rial rain size color,etc CI <br /> Ovefdrili to 25 feet b s.,backfill to surface Well Location <br /> with(neat cement ro t. Ad ress 71J75 West Eleventh Street <br /> Cit Tracy County San Joaquin <br /> Lata ude I N Longitude _yy <br /> i Dap. Min. Sec. Dep. Min. Sec <br /> m <br /> Dat NAD6 Dec.Lat. 37.7405435 Dec.Long.-121.4003180 <br /> APN Book 250 Page 140 Parcel 12 <br /> Township 2S Ran a 5E Section 22 <br /> Location Sketch Activity <br /> S fetch must be drawn by hand atter tam Is nted. O New Well <br /> ! North O Modification/Repair <br /> i O Deepen <br /> I O Other <br /> i O Destroy <br /> Dncrib.prooed -d mllk". <br /> rndor'GEOL OCIM LOO' <br /> i <br /> Planned Uses <br /> attached figure O Waters ic ❑ <br /> see <br /> g []Domestic Public <br /> w []Irrigation ❑Industrial <br /> O Cathodic Protection <br /> I O Dewatering <br /> O Heat Exchange <br /> O Injection <br /> O Monitoring <br /> O Remediation <br /> O Sparging <br /> I O Test Well <br /> i South <br /> - plu or G.crbe dsl.nce o(well from roede,lxrYdYp.,fences, <br /> O Vapor Extraction <br /> dren. .and seaeh a m.p.Use saaitlonY p•mer r neceusry. O Other <br /> PINe W aeeurete'snd eom Mte. <br /> Water Level and Yield of Completed Well <br /> 1 <br /> Dep h to first water (Feet below surface) <br /> Dep1h to Static <br /> Water Level;( Feet) Date Measured <br /> Total Depth of Boring Feet Esticited Yield` (GPM) Test Type <br /> Total Depth of Completed Weil Feet Tes Length (Hours) Total Drawdown (Feet) <br /> `Ma. not be representative of a well's long term yield. <br /> assns Annular Material <br /> Depth from BoreholeWall Outside Screen Slot Size Depth from <br /> Surface Diameter Type aterial Thickness Diameter Typo if!Any Surface Fill Description <br /> Feet to Feet inches Inches Inches inches Feet to Feet <br /> 1 <br /> i <br /> Attachments I Certification Statement <br /> Geologic Log I,the undersigned,certify is that this re ort complete and accurate to the best of my knowledge and belief <br /> ❑Weil Construction Dia ram Name Greag Dnllina&Testing In <br /> Person,Firm or corporation <br /> ❑Geophysical Log(s) t 950 Howe Rd O Martinez CA 94553 <br /> ❑Soil/Water Chemical*natysesSigned mss i city 10/31/2014 tate Zip <br /> El Other Site Ma <br /> Attest amuonat Information if it Ill C-67LiCjiftWvverwMC r Date Signed C-57 License Number <br /> DWR 188 REV.1/2006 ! IF ADDITIONAL SPACE IS NEEDED,USE NEX CONSECUTIVELY NUMBERED FORM <br /> t <br />