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ORIGINAL tit %I I Of ( 'Lt rt olt,"l D W R us go N L Y — QQ NOT F I r N <br /> File with DWR WELL COMPLETION REPORT 10, L5101-4-1E17-1 I <br /> Pale OF Reftr to Insrrniriun Pantphl,t STATE WELL NO/STATION NO <br /> Owner s Well No No F - `, ' ❑ <br /> I7 tte Work 13Egan 0 C t• _ 12 , 19 nded_ lC2_' � f7 � � LATITUDE LONGITUDE <br /> Loc TlPermltAgency San Joaquin CO. Health Dept . <br /> Permit No _g -_2 0 6 9 Permit Date APN/TR i TH R <br /> y CFOLOCIC LOC WELL OIVNER <br /> ORIENTATION (t VERTICAL — HORIZONTAL — ANGLE _ (SPECIFY) Name Eugene S ark s <br /> DEPTH FROM <br /> DEPTH f0 FIRST kv ALTER 104(Ft) BELOW SURFA(E Mailing Address 2 6 1 1 6 S . pat.t.e r S o n Pass R IJ <br /> I <br /> SURFACE DESCRIPTIONTracy__ _ Ca 95376 <br /> Fi to Fi Describe material grain reze color etc CITY STATE ZIP <br /> WELL LOCATION <br /> Top Soil Address. Patterso Pass Rd. & Hwy 580 <br /> 3 85 Shale City Trac <br /> 85 88 ; Fine Sana county San_ Joaquin _ <br /> 88 120 : Clay �n 4^ � <br /> APN Boot._Z Page parcel <br /> or <br /> 120 125 Fine Sand Streaks Township 0;'Z--� Range��Section <br /> 125 126 Sandstone Latitude I NORTH <br /> Longitude � (r_ WEST <br /> 1 261 30DEG MIN SEC <br /> r r DEG MrN SEC li <br /> LOCATION SKETCH ACTIVITY (if) <br /> ' 140 Sand NORTH NEW WELL <br /> 1 40 1 60 Clay & Shale MODIFICATION lREPAIR <br /> 150 <br /> 8 Sand <br /> � i Deepen i <br /> Cl <br /> 168 174 ay <br /> Other(Specify) <br /> 174 : 180 ; Sand <br /> ' 19Q Clay I <br /> DESTROY{Describe <br /> PrOCedures and Materials <br /> i Under GEOLOGICLOG) <br /> PLANNED USE(S) <br /> 3 w (� } <br /> i <br /> MONITORING <br /> r <br /> WATER SUPPLY <br /> X Domestic <br /> Public <br /> r._ Irrigation <br /> Industrial <br /> TEST WELL <br /> SOUTH ION ODIC PROTEC <br /> Illustrate or Descnbe Distance of Well from Landmarks OTHER(Specify) <br /> such as Roads Budd:nos Fences Risers etc <br /> PLEASE BE ACCUI(ATE Z COMPLETE <br /> DRILLING ��'�11.,++,.,,,,, <br /> METHOD Mud Rota y FLUID -We9t.Pr/RQntnn]t. <br /> WATER LEVEL & YIELD OF COMPLETED WELL <br /> DEPTH OF STATIC <br /> WATER LEVEL (Ft) & DATE MEASURED <br /> ESTIMATED YIELD' (GPM) & TEST TYPE <br /> TOTAL DEPTH OF BORING -1 9 0 ?Feet) TEST LENGTH (Hrs) TOTAL DRAWDOWN (Ft) <br /> TOTAL DEPTH OF COMPLETED WELL (Feet) *May not he representative of a wells long-term yield <br /> DEPTH CASINGS) DEPTH <br /> ANNULAR 'MATERIAL <br /> FROM SURFACE BORE <br /> HOLE TYPE FROM SURFACE TYPE <br /> INTERNAL GAUGE SLOT SIZE CE N <br /> DIA Ti- s- <br /> � i MATERIAL/ DIAMETER OR WALL IF ANY ENT TONITE FILLFt 10 Ft (Fnches) a 4 GRADE FILTER PACK <br /> m (inches) THICKNESS Onches) Ft to Ft (� ) (� ] (� ) (TYPEISIZE) <br /> 0 ; 1 55 12 X PVC 6 " 160sch 0 100 X <br /> II <br /> ATTACHMENTS (!) CERTIFICATION STATEMENT <br /> — Geologic Log I the undersigned certify that this report Is complete and accurate to the hest of my knowledge and belief <br /> Well Construction Diagram NAME H_E_N N I N G S BROS . DRILLING CO . , INC . �3 <br /> — Gecphyaicai Log(S) (PERSON FIRM OR CORPORATION)(TYPED OR PRINTED) <br /> — Sorl l Water ChemiCal Analyses 3525 P E L A N D A L E AVE . M O D E S T O CA 95356 <br /> — Other ADDRESS 1.1, <br /> {�t�1' CITY rt STATE IIP <br /> ATTACH ADDITIONAL INFORMATION IF IT EXISTS Signed � L 0 C T, 1 9, 19 9 3 290813 <br /> WELL DRILL EB AUTHORIZED REPRESENTATIVE DATE SIGNED C 57 LICENSE NUMBER <br /> DWEI IxrtifI N, 7q IF ADDITIONAL SPACE IS NEEDED USE NEXT CONSECUTIVELY NUMBERED FORM <br />