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Environmental Health - Public
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932
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2900 - Site Mitigation Program
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PR0527598
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Last modified
1/15/2020 5:40:13 PM
Creation date
1/15/2020 4:24:35 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
FIELD DOCUMENTS
RECORD_ID
PR0527598
PE
2960
FACILITY_ID
FA0018700
FACILITY_NAME
RIPON FARM SERVICES
STREET_NUMBER
932
STREET_NAME
FRONTAGE
STREET_TYPE
RD
City
RIPON
Zip
95366
APN
26102011
CURRENT_STATUS
01
SITE_LOCATION
932 FRONTAGE RD
P_LOCATION
99
P_DISTRICT
005
QC Status
Approved
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EHD - Public
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'The free Adobe Reader may be used to view and comp is form. However,software must be purchased to complete, and reuse a saved form. <br /> File Original with DWR State of California DWR Use Only—Do Not Fill In <br /> Page of Well Completion Report <br /> Refer to Insbucdon Pamphlet <br /> Owners Well Number MW-2 No. eO246376 State well Number/Site Numb�� <br /> Date Work Began 11/26/2014 Date Work Ended 11/26/2014 w <br /> Latitude Lon nude <br /> Local Permit Agency San Joaquin County Emimain ntal H alth <br /> Permit Number 70661 Permit Date 9/30/14 APN/TRS/Other <br /> Geologic Log Well Owner <br /> Orientation O Vertical O Horizontal OAngle Specify Name CA Army National Guard <br /> Drilling MethodAuger Drilling Fluid <br /> Depth from Surface Description Mailing Address 10260 Mather Blvd. <br /> Feet to Feet Describe material, rain size,color,etc City Mather State CA It, 95655 <br /> Overdrill to abandon 4"well to 56'and rout to Well Location <br /> surface Address 2000 Stimson Road <br /> City Stockton County San Joaquin <br /> Latitude N Longitude —tel <br /> Dea. Min. Sec. Deo. Min. Sec. <br /> Datum Dec.Lat. Dec.Long. <br /> APN Book Page Parcel <br /> Township Range. Section <br /> Location Sketch Activit <br /> Sketch murt be dram by hand after form is printed.7 0 New Well <br /> North <br /> 0 Modification/Repair <br /> O Deepen <br /> O Other <br /> (D Destroy <br /> D -G pmceam material; <br /> uMffer'GEOLGGGIC LLOG' <br /> Planned Uses <br /> 0 Water Supply <br /> ❑Domestic El Public <br /> 0 w ❑Irrigation ❑Industrial <br /> 0 Cathodic Protection <br /> 0 Dewatering <br /> O Heat Exchange <br /> 0 Injection <br /> 0 Monitoring <br /> 0 Remediation <br /> 0 Sparging <br /> South 0 Test Well <br /> nmurme or descnce dunce olr Ifom r—I.,cwume..r... 0 Vapor Extraction <br /> m,ctc.am.tmm.m.p.use addiiooal paper I m.cs.ar. 0 Other <br /> pkasrr eweuhnorm ca leto <br /> Water Level and Yield of Completed Well <br /> Depth to first water (Feet below surface) <br /> Depth to Static <br /> Water Level (Feet) Date Measured <br /> Total Depth of Boring Feet Estimated Yield' (GPM) Test Type <br /> Total Depth of Completed Well Feet Test Length (Hours) Total Drawdown_(Feet) <br /> *May not be re resentative of a well's long term yield. <br /> Casings Annular Material <br /> Depth from Borehole wall Outside Screen Slot Size Depth from <br /> Surface Diameter Type Material Thickness Diameter Type if Any Surface Fill Descri ration <br /> Feet to Feet Inches Inches Inches Inches Feet to Feel <br /> Attachments Certification Statement <br /> ❑Geologic Log I,the undersigned,certify that this report is complete and accurate to the best of my knowledge and belief <br /> ❑Well Construction Diagram Name Cascade Drillino L.P. <br /> ❑ Geophysical Log(s) Person,Firm or Corporation <br /> 3000 Q th St West Sacramento CA 95691 <br /> ❑ SoillWater Chemical Analyses 1 _ - coy State zip <br /> O Other Site Mao Signed `/✓� V r 12/12/14 936110 <br /> Atlach additional information if it exists. C-5T Lkensed Water ell Con r Date Signed C-57 License Number <br /> DWR 188 REV.112006 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />
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