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ORIGINAL STATE OF CALIFORNIA 00 NOT XiLL I <br /> Fits with DWR WELL COMPLETION REPORT <br /> ❑ <br /> - Page—I—of--t— Refer to ] STATE WELL NO/STATION NO <br /> n�truction Pamphlet ❑ <br /> Owner's Well "o- 749261 No. - LATITUDE LONGITUDE <br /> to Work Began MARCH 7.209?, Ended MARCH 7.2002 <br /> Local Permit Agency SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES-ENV DIV <br /> FEBRUARY 22 2002 APNrTRSlOTHER <br /> Perrrlrt No 28981 Permit Date i <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION (at.) VERTICAL —HOR WMAL _ANGLE ._..-(5PECwvJ Nam <br /> IIREITFwIt]D Hollow Steam Auger _ FLUID NONE Mallmg Address 8788 ELK GROVE 8 VD UIL IN 3 5Ui 1 <br /> DEPTH FROM L A V CA 24 <br /> SURFACE DESCRIPTIONa MW <br /> — <br /> FL Ic FL Describe material, grain size color, etc CITY <br /> 0 90 1 WELL BAddress <br /> BORING WAS NOT LOGGED OR SAMPLED WELL LOCATION <br /> ' <br /> / I t3ty <br /> r I County SANJOAQUIN <br /> r r APN Book Page Parcel <br /> 1 r Township Range Section <br /> I , Latitude, ' . 1T11 Longitude WEST <br /> DEG, MALL SEC DEG, MIN 5M <br /> LOCATION SKETCH ACTIVITY (-) <br /> ..� ✓ NEW WELL <br /> LIODIFIGATIONPREPAIR <br /> �,.►'^ pole♦ — Dampen <br /> 01her(8Ppd1y) <br /> r 1 � �.•«�+ � ', 1 ^-PDESTROY <br /> mesdwr <br /> es&W Alainhes <br /> Unddr-GEOLOOICiota) <br /> I I rI✓ z /-�'"liiw.lp * h • PLANNED USES OC) <br /> I �� a"- ^^ .\•hs,�� F T WATER SUPPLY <br /> s I GF4A „_ Domeuk PUNIC <br /> r � Parrlw <br /> rUSrs SP44Dew— t r.,,. ItKW1W4 IndutlriPl <br /> r i �1 '' NH4 <br /> 4 <br /> MONITORING— <br /> / i 1 - t +•! riFsi ♦ TEST WELL <br /> } <br /> r r �• 11w.1a Y' ldrre� a \^ l� GATHOOIC PROTECTlo" <br /> HEAT EXCHANGE <br /> rfF77 DIRECT PUSH <br /> r r ` ToelcQ •i '`Falmef • �� WUECirON <br /> �\ a 74 W i\0, VAPOR EXTRACTION <br /> Tea>< � <br /> r r SII t gip' �.o,dt/ 4, t SPARRING <br /> REMEDIATION— <br /> I r Bonk of Amato <br /> � 071 (SPECIFY) <br /> WATER LEVEL & YIELD OF COMPLETED WELL <br /> I i <br /> DEPTH TO FIRST WATER (FL)BELOW SURFACE <br /> I I <br /> DEPTH OF STATIC <br /> WATER LEVEL (FL)8 DATE MEASURED <br /> r I <br /> ESTIMATED YIELD ' (GPM)8 TEST - <br /> TOTAL DEFPH OF BORING 90 (Fee1) TEST LENGTH (Ells I TOTAL DRAWDOWI (FL) <br /> TOTAL D£PTH OF COMPLETED WELL 90 (Feet? •May rwr be rrprexwrarrvr e a welPr loll -rrrTw !dA <br /> CASING JS) DEPTH ANNULAR MATERIAL <br /> DEPTH BORE- FROM SURFACE TYPE <br /> FROM SURFACE HOLE TYPE(!) <br /> DIA. ' MATERIAL/ 0417JI IAL GAUGE SLOT SIZE CE- FILTER PACK <br /> Ihmsl 4 GRADE DIAMETER OIi WAIL IF ANY MEM tE <br /> FILL PE15A to FT. Ih-M) THICKNESS (rrchoe) Fr. m R ( t a) <br /> 0 r 676 8 ✓ PVC 075 Sch 40 0 I 8D ✓ <br /> 875 I 80 8 ✓ 2 Microsparge 80 I 85 ✓ <br /> 85 i 90 ✓ 2/12 Lonestar <br /> Send <br /> 1#r <br /> r <br /> r ATTACHMENTS (_) CERTIFICATION STATEMENT <br /> I,the undersigned,certify that Bus report is complete and accurate to the treat of my knowledge and belief <br /> — Geolo(pC log <br /> — Well Cunstructlon Diagram N ME WOODWARD DRILLING <br /> (PfMoIj TWK DR 41000RA110I0 (TYPED 9R PRBTTM) <br /> — Louts) 550 RIVER ROAD 1 P Q BOX 336 RIO VISTA CA 34571 <br /> — SWI ster chemical Analyses MDRIss Cin STATE VP <br /> Other <br /> ATTACH A00rTrOiygL rNFOFIMTrOM tF m EXrJrS JUNE 1S 2002 770079 <br /> WEU DRill UTH ZED REPRESENTOC lDA SIGHED <br /> 557 LICEIM WMI101 <br /> DWR 188 KIN It 9r7 IF ADDITIONAL SPACE IS NEE ED, USE NEXT CONSECUTIVELY NUMBERED FORA <br />