Laserfiche WebLink
ti <br /> "The free Adobe Reader may be used to view and complete turm. However,software must be purchased to complete,savereuse a saved form. <br /> File Original with DWR State of California DWR Use Only-Dd'Not Fill In <br /> Well Completion Report <br /> Page Of 1 Refer foMsiructanPamphlof <br /> Owners Well Number OSP28 No. e0180778 State vvelNNumberlSite Number, w <br /> Date Work Began 06110/2013 Date Work Ended .6,113/2013 Latitude Longitude <br /> Local Permit Agency 5aa Joaquin County Environmental Health Department <br /> Permit Number 0067164 Permit Date 5115/13 APNfrRS10ther <br /> GeologIcLog Well Owner <br /> Orientation OVerticai 0Horizontal OAngle Specify Name Lee Shocky <br /> Drilling Method Hollow Stem Auger Drilling Fluid none Mailing Address 205 Pedras Road <br /> Depth from Surface Description Turlock CA �i 95380 <br /> Feet to Feet Describe material,-grain size,.cotor,etc Cit State <br /> 0 50 Overdrill Well Location <br /> Address 850 Miloeo Avenue <br /> City Ripon County San Joaquin <br /> Latitude 37 746 269 N Longitude -121 131 65 w <br /> Deo- Min. Sea Deo. Min. Sea <br /> Datum Decimal Lat. Decimal Long. <br /> AF'N Book 261 Page 05Q Parcel 01. <br /> Township -Range Section <br /> -Location Sketch Activity. <br /> sketch musl.be drawn by hand,afler form is printed. O New Well <br /> North 0 Modification/Repair <br /> O Deepen <br /> O Other <br /> E) Destroy <br /> Gefvbe procedures orb matertah <br /> under•GEOLOGIC LOG' <br /> Planned Uses <br /> O Water Supply <br /> See Attached [:]Domestic ❑Public <br /> w ❑Irrigation ❑industrial <br /> O Cathodic Protection <br /> O Dewatering <br /> O Heat Exchange <br /> O Injection <br /> O Monitoring <br /> O Remediation <br /> O Sparging <br /> South O Test Well <br /> Illusrete or dascNbe dhlence of vrap tram roach,burdinps,Fences. O Vapor Extraction <br /> rhars,etc.and atl."h a map.use additional paper If necessary. O Other <br /> Pbs <br /> to be accurate and cam late. <br /> Witter Level and Yield of Completed Well <br /> Depth to first water (Feet below surface) <br /> Depth to Static <br /> Water Levee! (Feet) Date Measured - <br /> Total Depth of Boring 50 Feet Estimated Yield' (GPM) Test Type <br /> Test Length (Hours) Total Drawdown (Feet) <br /> Total Depth of Completed Well 50 Feet *Ma not be representative of a well's long term yield. <br /> Casings_ Annular Material <br /> Depth from Borehole Type Material Wall Outside Scroen Slat Size Depth from <br /> Surface Diameter yp Thickness Diameter Type if Any Surface Fill Description <br /> Feet to Feet Inches Inches Inches Inches Feet to Feet <br /> 0 47 8 Blank PVC Sch,40 314 1 45 Cement Portland 1111 <br /> 47 50 a Screen PVC Sch.40 314 Mesh Diffuse 45 46 Bentonite Pellets <br /> 46 50 Filler Pack #2112 <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 All Well Abandonment, Inc. <br /> Person,Firm or Corporation <br /> ❑ Geophysical Log(s) 9245 Beatty Drive Suite A Sacr mento CA 95826 <br /> ❑ SollfWater Chemical Analyses ;��' <br /> Address Ciiy State Zip <br /> I] Other Site Map __ Signed ' - 6/25/2013 848359 <br /> Attach additional irdomtation If It exists. - Ccs star wan Conu'aclor Date Signed C-57 License Number <br /> DWR 186 REV.11008 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />