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QUADRUPLICATE ' STATE OF CALIFORNIA E O l Y - 0 NOTFILL IN <br /> For Local Requirements '40' WELL COMPLETION REPORT <br /> n. P ge i of 2 A Refer to InstTg[tion Pampblet STATE WELL ANO./ST/TSTA—TION, NO. <br /> Owner's Well No. ENVIROP'l geft 7 7 3 —L� � � —'— —i.'--'11 <br /> Date Work Began an• • 199b , Ended JaAfiPd _I(t LATlnwE LONGITUDE <br /> 6. - Local PermitAgene San Job uin Hea t. <br /> APNITTISIOTIJER <br /> Permit No. �115 Per i <br /> GEOLOGIC LOG WELL OWNER <br /> l� ORIENTATION (L) X VERTICAL HORIZONTALd. <br /> 20_ANGLE (SPECIFY) Name Dan S c h a a pm a n/Riverside R a n c h <br /> DEPTH TO FIRST WATER BELOW SURFACE MRiljng��dress acetone 85366 <br /> DEPTH FROM NN 11 p <br /> SURFACE DESCRIPTION <br /> Ft. to Ft. D&mbe material,grain size,color,etc. CITY WELL Q CATION STATE TIP <br /> p 5011 Address ver <br /> i ; 15 Sane City xaxRipon <br /> is :2b bandy Clay County San Joaquin <br /> 2S 14 Z0411FICI.54 <br /> r e APN Book Page Parcel <br /> or:41 Sand anTownship Range Section <br /> 41 !47 Latitude NORTH Longitude WEsr <br /> se <br /> 47 NIV <br /> ,/ DEG. MIN. ' SEC. DEG. MIN. SEC. <br /> GravelLOCATION SKETCH ACTIVITY (2L) <br /> NORTH NEW WELL <br /> 50 56 clay MODIFICATION/REPAIR <br /> —Deepen <br /> 59 !68 Clay <br /> Omer(specify) <br /> F58 ; 70 Sand & Gravel <br /> DESTROY(Describe <br /> Proceduresi nd Meterula <br /> Under"GEOLOGICLOG'7 <br /> l- PLANNED USE(S) <br /> w a (!L) <br /> 1103 iO/ Clay 3 W MONITORING <br /> WATER SUPPLY <br /> IDS 110 Clay — Domestic <br /> 110 : 113 Sand & Gravel T Public <br /> Irrigation <br /> Industrial <br /> "TEST WELL" <br /> CATHODIC PROMO. <br /> SOUTH TION <br /> Illustrate or Describe Distance of Well from Landmarks — OTHER(Specify) <br /> 131 1150 Salf" such as Roads,Buildings,Fences,Ricers,etc. <br /> 150 152 Clay & Shale PLEASE BE ACCURATE 4 COMPLETE. <br /> GRILLING Reverse Rotary Bentonite/Water <br /> METHOD FLUID <br /> WATER LEVEL 6 YIELD OF COMPLETED WELL <br /> 161 169 Sand DEPTH OF STATIC SEE <br /> 169 176 Clay 3 Shalle WATER LEVEL ,E,(F(j]I A DATE MEASURED <br /> ' "`*GPM <br /> ESTIMATED VIELd� ) & TEST TYPE <br /> TOTAL DEPTH OF BORING (FgbO TEST LENGTH— (Hra.) TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL GGyU (Feet) 'May not be>ep'reseruative of a well i long-term yield. <br /> DEPTH CASING(S) DEPTH ANNULAR MATERIAL <br /> BORE- � <br /> FROM SURFACE HOLE 7ypE � FROM SURFACE TYPE <br /> DIA. W c GAUGE SLOT SIZE <br /> !L MATERIAL/ CE- BEN <br /> DIAMETER HI WALL IF ANY FILTER PACK <br /> (Intoes) z W ion a GRADE MENT TGNRE FILL RypE/SIZE) <br /> Ft. to FL Onchas) THICKNESS (Inches) Ft. to Ft. <br /> ee ga <br /> ee lbas 140ga FuT Flo <br /> ee ga <br /> 9 11 <br /> Sch 60 <br /> ATTACHMENTS CERTIFICATION STATEMENT <br /> — Geologic Log <br /> I,the undersi ned,certif that this report is complete and accurate to the beat of my knowledge and belief. <br /> Ia <br /> — Well Construction Diagram NAME NNING BROS. DRILLING CO. , INC <br /> Geophysical Log(.) <br /> (PER 15PIR%ORPI P.OIt1T(OjIZ(]1itE OR Pit1lI1;f0: MODESTO CA 95356 <br /> Soil/Water Chemical Analyses [ tt�A��JJ�tJ�{L AYt <br /> ADDRESS _ CITY STATE ZIP <br /> Other Signed `D, - � JANe24,1995 290813 <br /> ATTAtx/ADDITIONAL INFORMATION. IF IT EXISTS. WELL DRILLER AUTHORIZED REPRESENTATNE DATE SIGNED C57 LICENSE NUMBER <br /> see, DWRIMREV T-go IF ADDITIONAL SPACE IS NEEDED, USE NEXT CONSECUTIVELY NUMBERED FORM <br />