Laserfiche WebLink
"The tree Adobe Reader maybe used to view and complete tttlfin However,software must be p.irchased to complete,save,uuse a saved form. <br /> File Original with DWR State of Caljfomia DWR Use Only-Do Not Fill In <br /> Page of 1 Well Completion Report <br /> Refer to Insfructlon Pamphlet State Well Number/Site Number <br /> Owner's Well Number 0SP36 No. e0180781 FI 1 1 N1 1 1 1 t Iw <br /> Date Work Began 06110/2013 Date Work Ended 6/13/2013 _ Latitude Longitude <br /> Local Permit Agency <br /> Permit Number 0067764 Permit Date 5115113 APN1TRSrOther <br /> Ge6lo is Log- Well Owner <br /> Orientation OVertical O Horizontal OAngle Specify Name Lee Shocky <br /> Drilling Method Hollow Stem Auger Drilling Fluid none <br /> :Depth from Surface Description Mailing Address 205 Pedras Road <br /> Feet to Feet Describe material,graln size,color,etc Lly Turlock State—CA —zip 95380 <br /> 0 50 Pressure Grout Well Location <br /> Address 850 Miiaeo Avenue <br /> City Ripon County San Joaquin <br /> La titude 37 746 269 N Longitude -121 131 65 w <br /> Deo, Min. Sec. 'Deq. Min. Sec. <br /> Datum Decimal Lat. Decimal Long. <br /> APN Book 261 Page 050 Parcel 01_ <br /> Townshj Rana Section <br /> Location Sketch Activit <br /> sketch must be drawn by hand after form is printefl O New Well <br /> North O Modification/Repair <br /> O Deepen <br /> O Other <br /> Q Destroy <br /> OvoalOe pr«wot and meserleh <br /> under'GEOLOGIC LOG' <br /> Planned Uses <br /> O Water Supply <br /> ❑Domestic ❑Public <br /> SBE Attached N ❑irrigation ❑Industrial <br /> cu <br /> O Cathodic Protection <br /> O Dewatering <br /> O Heat Exchange <br /> Q injection <br /> O Monitoring <br /> O Remediation <br /> O Sparging <br /> South O Test Well <br /> tAuepate a desnme dstanoe of w ll kern roads.burldrp,fences, O Vapor Extraction- <br /> riven,etc.and attach a map.1Dse addWat paper 11 necessary. 0 Other <br /> Flamm be accurate and compkflo. <br /> Ater Level and Yield of Completed Well <br /> Deplh to first water (Feet below surface) <br /> Depth to Static <br /> Water Level (Feet) Date Measured <br /> Total Depth of Boring 50 Feet Eslimated Yield" (GPM) Test Type <br /> Teat Length (Hours) Total Drawdown (Feet) <br /> Total Depth of Completed Well SO Feet *Ma not be representative of a well's long term yield, <br /> Casings Annular Material <br /> Depth from Borehole Type Material wall Outside Screen Slot Size Depth from <br /> Surface Olameter Thickness Diameter Type if Any Surface Fill Description <br /> Feet to Feet Inches Inches Inches Inches Feet to Feet <br /> 0 147 8 Blank PVC Sch.40 314 1 145 Cement Portland fill <br /> 47 150 8 Screen PVC Sch.40 314 Mesh Diffuse 45 46 Bentonite Pellets <br /> 46 50 Filter Pack #2/12 <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 /> 13 Well Construction Diagram Name All Well Abandonment, Inc. <br /> © Geophysical LOg{5} Person,Firm or Corporation <br /> 9245-Beatty Drive, Suite A eramento CA 95826 <br /> ❑ Soil/Water Chemical Analyses Address - City State zip <br /> 0 Other Site Map _._ Signed 6/25/2013 848359 <br /> Allarh additivno trttomwbon it It ts. tsnfe ar well Contractor Date Signed C-57 License Number <br /> DWR 188 REV.V2006 IF ADDITIONAL SPACE IS NEEDED,USE NE>;T CONSECUTIVELY NUMBERED FORM <br />