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ORIGINAL STATE OF CALIFORNIADWR USE ONLY — 00 11101 E16L IN— <br /> File with DWR WELL COMPLETION REPORT 11 11-111 I -U <br /> STATE WELL NOJBTATION NO <br /> Page_I—of-�.1 Refer to Inirrucffon Falnphltr � ❑ <br /> ovlrnell°a Well No. "°- 749262 <br /> LIDE <br /> ate Work Began A 0 , Ended MARCH 002 LATITUDE LaNai — <br /> ii <br /> Local Permit Agency SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES-ENV DIV APN(TRSIOTHER <br /> Permit No, 28981 Permit Date FEBRUARY 22,2002 <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION (2C) ✓vERTICAL _HOR=NTAL —ANGLE —{SPECIFY) Name UbjQQAL gQRP0FjAT <br /> ON <br /> MONG <br /> OD Hallow Steam Auger FLUID NONE Mailing Address 8788 ELK G OVE BLVD BUILDING 2.8UrT9 15 <br /> DEPTH FROMIA 95624 <br /> SUR --r:LK GROVEFACE DESCRIPTION <br /> FL ro FI Describe Ineitenal grain sue, color etc COY SLAT£ ZIP <br /> WELL LOCATION <br /> Address <br /> 0 90 r WELL BORING WAS NOT LOGGED OR SAMPLED <br /> I 1665 PACIFIC AVE- <br /> Cltv 2MCKMOK CA <br /> County SAN JOAQUIN <br /> r APN Book Page Parcel <br /> r Township Range Section <br /> I Latitude INOM Longitude WEST_ WESTDEG MIN, SEC DEG MTN SEC <br /> , LQ <br /> A N SKETCH _ ACTIVITY (4) <br /> �} � ✓ NEW WELL <br /> M]ODIFICATIONIREPAIR <br /> T Deepen <br /> I I �• <br /> DESTROY(Desarba <br /> r I +l A 5\+ 01dq-GEOLOGIC 1.007 <br /> PLANNED USES (=) <br /> r r r *F*B •pF77 WATER SUPPLY <br /> S Fanwc Daargtic PrrPio <br /> us% i Y,�o i ktglnlon InAualnal <br /> y MONITOR" <br /> tf <br /> YF v ; TEST WELL <br /> r r �� x'14 •MG <br /> \ CATHODIC PROTECTION <br /> ;t IrIWa a HEAT EIICNMI(;IE.� <br /> rea i11 DIRECT Push <br /> ti Fmuw L�.,'�fbrnc rlrN.,Ii <br /> I r SIOL" Neale W LWMX 1 INJECTION— <br /> r r � #L• Torp \ <br /> ti VAPOR EXTRACTION <br /> r r v _ 9 ` SPARGWG✓ <br /> OWNREWEIJi ION—„- <br /> a�W kflatsa I � OTHER(SPECIFY)— <br /> WATER LEVEL & YIELD OF COMPLETED WELL <br /> r r <br /> DEPTH TO FIRST WATER (FL)BELOW SURFACE <br /> r r DEPTH OF STATIC <br /> r ' WATER LEVEL (FN)d DATE MEASWED <br /> r EST7M11TED YIELD' (GPM)6 TEST <br /> TOTAL DEPTH OF BORING 90 (Feet) TEST LENGTH (Hm)TOTAL DRAWDOwFL—(FL) <br /> TOTAL DEPTH OF COMPLETED WELL 90 (Feet) 'Mq nor be npsesesrersue ofa Bid's l I -ternsY14 <br /> DEPTH BORE CASING (S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE HOLE TYPE FROM SURFACE TYPE <br /> DIAW MATEFUAL I INTERNAL GAUGE SLOT SIZE �' FILTER PACK <br /> {triehes) GRADE DiAKjMfl OR WALL IF ANY MErJTIT <br /> O FILL Ef9R <br /> Ft w FL 2 prulnq <br /> THICKNESS FL la Fl <br /> 41 <br /> 0 r 97 5 a ✓ PVC 075 Sch 40 0 I 80 ✓ <br /> 875 + 90 8 vl 1 2 Mlcrosparge 80 I 85 ✓ <br /> t35 r 90 ✓ 2112 Lonestar <br /> I Sand <br /> r 1 <br /> r ATTACHMENTS (jt) CERTIFICATION STATEMENT <br /> awkw Log I the undersigned,certAy that INS report is Complete and accurate to the best of my WwWiedge and belles <br /> [ArrAC#4 <br /> — WE4 Construction Diagram AIauE WOODWARD DRILLING <br /> 1PERSOX Fifilk OR CORPORATIDIO (TYPED OR FRINGED) <br /> +vw Chwnl) 550 RIV ROAD I P O BOX 336 RIO VISTA CA 94571 <br /> SolWy t CRarNcel Arlalysea CITY STATE <br /> Osler AODRE4S <br /> DDlnoAwt rrvForttAfaTlorrC IF Ir FxIsT^_i d JUNE 19 2002 77 0078 <br /> riELL WAOTIlOR1IED REPRESIMA GATE S7 t-ST tf Erb ikIIADER <br /> DNR 198 REV 11-97 IF ADDITIONAL SPACE is N EDED USE NEXT CCMSECUTIVELY NUMBERED FORM <br />