WP0036982 - Laserfiche WebLink

Home Browse Search

'The free Adobe Reader may be used to view and complete this form. However,software must be purchased to complete,save,and reuse a saved form. File Original with DWR State of California DWR Use Only—Do Not Fill In Well Completion Report Page 1 Of 1 Refer to Instruction Pamphlet State Well Number/Site Number Owner's Well Number WP0036982 No. XXXXXXX N w Date Work Began 08/12/2017 Date Work Ended 8/17/2017 Latitude Longitude Local Permit Agency San Joaauin Permit Number WP003682 Permit Date 8/2/17 APN/TRs/Other Geologic Log Well Owner Orientation O Vertical O Horizontal OAngle Specify Name Hoanhi Foster Drilling Method Direct Rotary Drilling Fluid Fresh Water Mailing Address 17200 W Byron Rd Depth from Surface Description Feet to Feet Describe material,grain size,color,etc City Tracy State Ca 7i 0 10 Top Soil Well Location 10 70 Sand Address 17190 W Byron Rd 70 80 Coarse sand City Tracy County San Joaquin 80 108 Sand Latitude N Longitude w 108 142 Clay Deq. Min. Sec. Deq. Min. Sec. 142 184 Sand Datum Dec.Lat. Dec.Long. 184 192 Coarse sand APN Book Page Parcel 192 260 Sand 1 Township —Range Section Location Sketch Activity Sketch must be drawn by hand after form isprinted.) Q New Well North Q Modification/Repair O Deepen O Other Q Destroy Describe procedures and materials under"GEOLOGIC LOG' Planned Uses Water Supply [DDomestic ❑Public w ❑Irrigation ❑Industrial Q Cathodic Protection Q Dewatering 2017 Q Heat Exchange Q Injection ONMENTAI llmii Q Monitoring 11JERMIT/sFRIarr.0 Q Remediation Q Sparging South Q Test Well Illustrate or describe distance of well fmm roads,buildings,fences, Q Vapor Extraction rivers,etc.and attach a map.Use additional paper if necessary. Q Other Please be accurate and complete, Water Level and Yield of Completed Well Depth to first water 80 (Feet below surface) Depth to Static Water Level (Feet) Date Measured Total Depth of Boring 300 Feet Estimated Yield* (GPM) Test Type Total Depth of Completed Well 300 Feet Test Length (Hours)Total Drawdown (Feet) *May not be representative of a well's long term yield. Casings Annular Material Depth from Borehole Type Material Wall Outside Screen Slot Size Depth from Surface Diameter yp Thickness Diameter Type if Any Surface Fill Description Feet to Feet Inches Inches Inches Inches Feet to Feet 0 200 12 Screen PVC Sch.40 SDR 21 6 1 0 1125 Bentonite Grout well DF 200 260 12 Blank PVC Sch.40 SDR 21 6 125 260 Filter Pack Pea Gravel LI i i I — i i Attachments Certification Statement ❑ Geologic Log I,the undersigned, erti that this report is complete and accurate to the best of my knowledge and belief El Well Construction Diagram Name Castle C f tion&Well Drilling 13Geophysical LO Person,F r rporation g(S) 1001 S Ivan A S 'e A Modesto CA 95354 ❑ Soil/Water Chemical Analyses -- Cay Sate zip ❑ Other Signed 08/20/2017 996768 Attach additional information if it exists. C-57 fis n ed ater Well Contractor Date Signed C-57 License Number DWR 188 REV.1/2006 IF ADDITIONAL SPAC NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM