Laserfiche WebLink
`The free Adobe Reader may be used to view and complete this farm. However,software must be purchased to complete,save,and reuse a saved form. <br /> File Original with DWR Slate of California -DWRUse O y"Do Not Fill In <br /> Page 1 of 1 Well Completion Report <br /> Refer m lnswclim Pamphlet State Well IN Number <br /> Owner's well Number 9-120 No. e0095088 <br /> Date Work Began 06/255/2009/2009 Date Work Ended 6/25/2009 Latitude Lon Itude <br /> Local Permit Agency San Joacuin County Environmental Health Department <br /> Permit Number 57427 Permit Date 5/29/09 APN/TRS/Other <br /> Geologic Log Well.Owner <br /> Orientation OVertical O Horizontal OAngle speoif Name Sara Lee Bakery Group Inc. <br /> Drilling Method Hollow Stem Auger Drilling Fluid <br /> Depth from Surface I 1 1 Description - Mailing Address 3500 Lacey Road <br /> Feet to i .Feet Describe malerlal, rain size color,etc City Downers Grove State Iii 60515 <br /> See attached aeoloctic boring log Well:Cocation - <br /> Address 1444 South Lincoln Street <br /> City Stockton County San Joaquin <br /> Latitude _ N Longitude__Jm <br /> Deo. Min. Sec. Dap. MN. Sec. <br /> Datum NADes Decimal Lat. 37.9368675 Decimal Long.-121.292(H <br /> APN Book— Page -Parcel <br /> Township 1 North Ran e 6 East Section_15 <br /> 2Locatton Sketch Activit <br /> Sketch muss be drawnby IlenE aeerfoim is nnted New Well <br /> North O Modification/Repair <br /> O Deepen <br /> O Other <br /> 0 Destroy <br /> oe:<nce wewdu,...na maeeei� <br /> under"GEOLOGIC LOG" <br /> "Planned'Uses <br /> 0 Water Supply <br /> ❑Domestic ❑Public <br /> 3 w ❑Irrigation ❑Industrial <br /> 0 Cathodic Protection <br /> O Dewatering <br /> 0 Heat Exchange <br /> 0 Injection <br /> t 0 Monitoring <br /> ' - 0 Remediation <br /> 0 Sparging <br /> _ South 0 Test Well <br /> iru.sau or macnoe adnnce orwxrfmm n.a,lulahlas.mrlm 0 Vapor Extraction <br /> rbsr.,em..metaaemao-G.eaddltlm 11.ffnee.eeery... 0Other <br /> Plaewbaaccunteebd.em i.Le. <br /> ater Level and Y Sia Coif'let'ed':Weil <br /> Depth to first water (Feet below surface) <br /> Depth to Static <br /> Water Level (Feet) Date Measured <br /> Total Depth of Boring 120 Feet Estimated Yield' (GPM) Test Type <br /> Total Depth of Completed Well 120 Feet Test Length - (Hours)Total Drawdown_(Feet) <br /> May not be representative of a well's long term yield. <br /> Casings: 'AnnularMaterlal <br /> Depth from Borehole Wall Outside Screen Slot Size Depth from <br /> Surface Diameter Type Material Thickness Diameter Type If Any Surface Fill Description <br /> Feet se Feet Inches Inches Inches Inches Feet to Feet <br /> 0 110 8 RISER PVC Sch:40 1 12 1 1 0 1 Cement Concrete <br /> i <br /> 110 120 8 Screen PVC Sch-40 2 1 Miged slots 10.010 1 106 Grout Type II-IV Cement <br /> 106 108 Bentonite 3/8"Bentonite Chip <br /> 108 120 Filter Pack #2/12 Sand <br /> i <br /> Attachrrieritex „ } " Certification;StaRetiient: <br /> ❑ Geologic Log I,the undersigriedoertift that is r�aart let and accurate to the best of my knowledge and belief <br /> 0 Well Construction Diagram Name V R11 �11�1n-� <br /> Pe rmo C oration —/ <br /> -❑Geophysical Logs <br /> ❑Soil/Water Chemical Analyses ss a state `[�y ip <br /> El Other Map Signed N I?J d 7�{5 1 C5 <br /> Attach addREV.l information.'d it exists. - 7 Lk ater well contractor Date Si ne - C-57 License Number. <br /> DWR f ee REV.1/2086 IF ADDITIONAL SPACE 18 NEEDED,USE NEXT CONSECU-rMELY NUMBERED FORM _ <br />