Laserfiche WebLink
'The free Adobe Reader Maybe used to view and complete Is form, However,software must be purchased to complete,sand reuse a saved form. <br /> File Original with DWR <br /> State of California DWR IJ Onl –Do Nol FIII In <br /> Well Completion Report - <br /> Page 1 of 1 Refer to lnsauonon Pamphlet State Well Number/Sire Number w <br /> Owner's Well Number MW <br /> .12 No. e0166783 I N 1 <br /> Date Work Ended 12/14/9012 Latitude Lon nude <br /> Date Work Began 1211112012 •- <br /> Local Permit Agency '' Gnvironmental Health Department XP-NrtRslOaler <br /> Permit Number 66163 Permit Date 11/15/12 <br /> Geologic Lo Well Owner <br /> Orientation OVenical O Horizontal OAngle Specify [N�,ime City Df Riverbank <br /> Drilling Method Hollow Stem Au er Drilling Fluid Bentonite mud iling Address 6707 Third StreetDepth from Surface Description l Riverbank State CA Zi 95367 <br /> Feet to Feet Describe material rain size,color,etc <br /> 65 0 See below well installation details Well Location <br /> Address Wastewater Treatment PIant/Santa Fe Road <br /> City Riverbank County San Joaquin <br /> Latitude — N Longitude _. <br /> eo. Min. Sec. Dec. Mln. Sec. <br /> Datum Decimal Lat. Decimal Long. <br /> APN Book 249 _ Page 06 Parcel 013 <br /> Tnwnshi Ran a Section <br /> Location Sketch Activit <br /> l Sketchmustmdrav,nD hand aiterfomi is pnnted. (j) New Well <br /> North 0 Modifcetion/Repair <br /> O Deepen <br /> 0 Other <br /> — <br /> 0 Destroy <br /> D..-"e1«eauree.nd m.len.l. <br /> under veoLoGlc LOG <br /> Planned Uses <br /> 0 Water Supply <br /> []Domestic El Public <br /> ❑Irrigation ❑Intluslrial <br /> w <br /> ' 0 Cathodic Protection <br /> 0 Dewatering <br /> 0 Heat Exchange <br /> 0 Injection <br /> 0 Monitoring <br /> 0 Remediation <br /> 0 Sparging <br /> 0 Test Well <br /> South <br /> Vapor Extraction <br /> .. , <.cc.um. :uuo»u eom rwaaana...en<: <br /> .. ...tm..d.ft..ma , O <br /> Other <br /> ,se n.r <br /> aria c«n tale. <br /> 'tater Level and Yield of Completed Well <br /> Depth to first water (Feet below surface) <br /> Depth to Static <br /> Water Level (Feet) Date Measured <br /> Total Depth of Boring 65 Feet Estimated Yield (GPM) Test Type <br /> -fest Length (Hours) Total Drawdown—(Feet) <br /> Total Depth of Completed Well 65 Feet vlav not be re resentative of a well's long term yield. <br /> Casings Annular Material <br /> Depth from Borehole wall Outside Screen Slot Size Depth from <br /> P Type Material Thickness Diameter Type If Any Surface FIII Description <br /> Surface Diameter <br /> Feet to Feet Inches Inches Intoes Inches Feet to Feet <br /> 65 50 8 Screen PVC Sch.40 2 Milled Slats 0.020 65 48 Filter Pack 92/12 <br /> 50 0 8 Blank PVC Sch.40 2 48 45 Bentonite Chips <br /> 45 1 Cement <br /> Attachments Certification Statement <br /> El Geologic Log I,the undersiggned,certify that this report is complete and accurate to the best of my knowledge--and <br /> ❑Well Construction Diagram Name All Well Abandonment <br /> Parson,Firm or corporatum <br /> ❑ Geophysical Log(s) 9245 Beatty Drive Suite a ramento CA 95826 <br /> ❑ Soil/Water Chemical Analyses Aaap-�,.✓ J- City State zip <br /> ED Other Site Mao signed <br /> --`% 12/19/2012 848359 <br /> Arrant additional MwArratm 8itexisb. . +`C'S'7 Ntan ware c6ntrzctor Date Signed C-57 License Number <br /> DWR 188 REV.12006 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />