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ORIGINAL H SPATE OF CALIFORNIA Y <br />' File with DWR WELL COMPLETION REPORT O 1 11 <br /> Pagel of—L Refer CO ltsstrsictroa Pgmpbler STATE WELL NO/STATION NO <br /> Owner's Well No _c *; gp 13-QT No489309 ❑ ❑ <br />' Date Work Began - 0-13-!tRl, Ended 10-15-91 -' LATITUDE LONGITUDE <br /> Local Permit Agency_ San Joaquin Public' Health Sere_Ina ` <br /> Permit No 91-1041 Permit Date ^ <br />' GEOLOGIC LOG F fWELL OWNER <br /> ORIENTATION {!) �� VERTICAL —HORIZONTAL T ANGLE —(SPECIFY) Name <br /> C t- <br /> DEPTH TO FIRST WATER (FL) BELOW SURFACE , Mailing Address P.O. Box-1150 <br /> DEPTH FROM �, '� San ,Jose\ _''�"✓ CA 95108 <br />' SURFACE 1 DESCRIPTION C i - STATE ZIP <br /> Ft to Ft Describe material,grans nu,calor,etc : —' WELL LOCATION <br /> AddressF <br /> ' Abandon well by filling� w/10 sack ` C,ty, Stockton` F- <br />' cement mix n '/' County San Joaquin <br /> San Joaquin Ins ector present` .-' APN Book ` `Page Parcel <br /> Township Range Q 6 E Section_34 130 J <br /> t ° J Latitude NORTH Longitude WEST <br /> DEG MIN SEC DEG MIN SEC <br /> ' LOCATION SKETCH ACTIVITY (if.) <br /> NORTH-' - NEW WELL <br /> L r i <br /> MODIFICATION/REPAIR <br /> i r�]O:wC G^� �.Deepen <br /> ` V 1� V Cr 7 Othor(Spewty) <br /> O <br /> 1 N ry l N <br /> ESTROY(Describe <br /> � 'A Procedwae■rid Maforrefe <br /> N Under GFOLOGICLOG 7 <br /> Co 40' PLANNED USES) <br /> W fes) <br /> � _ MONITORING <br /> 1 ' Z TELL ¢ WATER SUPPLY <br /> i Z h Domee,ic <br /> Public <br /> Irrigation <br /> 4 <br /> i _ Industrial' TEST WELL <br /> 1 i <br /> CATHODIC PROTEC <br /> i SOUTH TION <br /> Illustrate or Describe Distance of Wel!from Landmarks ..._OTHER(Speedy) <br /> such as Roads Buildings Fences Revers etc <br /> PLEASE BE ACCURATE rr COMPLETE <br /> DRILLING <br />' METHOD FLUID <br /> WATER LEVEL & YIELD OF COMPLETED WELL <br /> DEPTH OF STATIC <br /> WATER LEVEL (Ft) 8 DATE MEASURED <br />' ESTIMATED YIELD (GPM) 8 TEST TYPE <br /> TOTAL DEPTH OF ROTTING (Feel) TEST LENGTH (Kra) TOTAL DRAWDOWN (FI) <br /> TOTAL DEPTH OF COMPLETED WELL (Feet) 'May not be representativr of a well's long-term yield <br />' <br /> DEPTH CASING(S) DEPTH ANNULAR MATERIAL <br /> BORE FROM SURFACE TYPE <br /> FROM SURFACE HOLE VTYPEINTERNAL GAUGE SLOT SIZEDIA d MATERIAL/ DIAMETER OR WALL IF ANY CE B£N FILTER PACK <br /> pnchesl e MENT TONITE FILL <br /> Ft to Ft <br /> GRADE pnchsa) THICKNESS Mehee) Ft to Ft (TYPElSI2E) <br /> w <br /> ATTACHMENTS CERTIFICATION STATEMENT <br /> I the underC A&- sign certify at this report is complete and accurate to the best of my knowledge and belief <br /> GeotogicLog DI D8A ENTERPRISES INC, dba NOACK PUMP COMPANY <br />' Well Conatruction Diagram N <br /> (Km OR RATION) (TYPED OR PRINTED) <br /> GeophyalcalLog(&) 0 E EMONT ST. STOCKTON CA 95215 <br /> SW/Watw Chamical Analyasa PTY STATE � <br /> X Odter. copy of County GEN'L MGR r� <br />' 4513 <br /> ATTACH ADDTTTOAM INF bIRA ATI F ITE STS. Signed2 5Q <br /> REPRESEKTATNE DILATE�SIC11Ep 1 97 LICENSE MMBER <br /> DWR 1811AEV 7 go IF ADDITIONAL SPACE IS NEE"E NEXT CONSECUTIVELY NUMBERED FORM <br />