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ORIGINAL N7%rl• (7t t %i u( n%j 1 DWR USE ONLY — 00 NOT-FILL I <br />' File w4 DWF! WELL COMPLETION REPORT v ,-,I ,I c Ic1 3 <br /> Page—of <br /> R.lir to lastru.tion Pampbicr STATE WELL NO tSTATION NO <br /> 1 ❑ <br /> Owner u Well No 03/28/9' 525334 1:1 <br /> tie Work 134 gar] I n(h d LATITUDE LONGITUDE <br /> (K II P4 rrnit Agtic1 APNI r <br /> N rrritt NO P4 rmlt D ite <br />' x ( FOLD( 1( IU( WEI I UWNNR <br /> ORIENTATION (!) VERTICAL — HORIZONTAL w ANGLE _ (SPECIFY) NarT]( M�orm.�n s� l„�aY_Pr S.�c�nmc. _ Tnc <br /> >7FPTE1 TO FiHtir 4iATFH fEt) 111,1­0%k 1lRFk('F <br /> SURFACE DFSCRIYTION Mailing Addr,, 2120 Wilcox R� <br /> DEPTH FROM Stockton CA 95215 <br />' cin size color etc GTY STATE ZIP <br /> Ft to F1 Describe malmal <br /> qr WELL LOCATION <br /> O 15 : soil Address 19450 Hidden Lakes Lane <br /> 5 i35 iClay City Woodbridge <br />' 35 : 45 : Coarse Sand county San Joaquin <br /> 45 : 55 Clay kPN Rook Page Parcel <br /> 55 88 Coarse Sand & GravelTownship Range Section <br /> 88 ' 100 ' Cla Latitude NORTH Longitude t I _ WEST <br /> 100 i 110 :Sand Coarse DEG Mitt SEC DEG MW SEC <br /> 110 128 Cls X <br /> LOCATION SKETCH ACTIVITY (�)— <br /> �_ NEW WELL <br /> 128 ; 148 ' SAnd & Gravel & Rock MODIFICATION/REPAIR <br />' 148 : 150 ; Clay _Deepen <br /> 150 : 161 Sand & Gravel & Rock _Omer(Speciy) <br /> 161 ' 225 ' Cls <br />' <br /> 225' ' Sand <br /> ._.DESTROY(r>•acrtbe <br /> 228 : 245 : Clay t' `or GEouxICLOGri <br /> 245 : 251 : Sand good PLANNED USE(S)- <br /> 2 51 1325 Clay Ut 3 w _ MONITORING <br /> WATER SUPPLY <br /> X <br /> Domestic <br /> _ PuClm <br /> + ,_._. Irngatian <br /> industrial <br /> ' TEST WELL <br /> CATHODIC PROTEC <br />' SOUTH TION <br /> Illuserate or Describe Distance of Well from LandmaOTHrks — OTHER(Spadry) <br /> such as Roods Buildings Fences Rtuers etc <br /> PLEASE BE ACCURATE & COMPLETE <br /> ILLING <br /> MRETHOD ROTARY FLUID WATER <br /> WATER LEVEL h YIELD OF COMPLETED WELL <br /> DEPTH OF STATIC <br /> WATER LEVEL 40 (Ft) 3 DATE MEASURED <br />' ESTIMATED YIELD' (GPM) S TEST TYPE <br /> TOTAL DEPTH OF BORING 325 (Feet) TEST LENGTH (Hrs) TOTAL DRAWDOWN (Ft) <br /> It TOTAL DEPTH OF COMPLETED WELL 265 (Feet) •May not be repreaemarme of a well's long-term yield <br /> DEPTH CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE �E TYPE � FROM SURFACE TYPE <br /> r INTERNAL GAUGE SLOT SIZE <br /> MATERIAL! CE BEN <br /> A W Z DIAMETER OR WALL IF ANY FILTER PACK <br /> FI to Ft (kieheal I = s GRADE Diiches) THICKNESS (Inches) FI to Ft MENT TONiTE FILL (TYPE/SIZE) <br /> 245 31PLASTIC 6 160 00 X <br /> %TTICHME\TS (!► CERTIFIC�TIU\ STkTE%IENT <br /> .— Geo"ic Log I the undersigned certify that this report Is complete and accurate to the best of my knowledge and belief <br /> Well Construction Diagram NA14ErPA <br /> (PE ( NN EMINC <br />' GeophysicalLog(s) <br /> S"i Water Cheffueat Analyiea 119 rn Rd modp--:to <br /> ADDRESS CITY 51ATE � <br /> Other / <br /> ArrACH AOD/170P1A! WIFORAMrA0A1 IF IT EJUSrs04/02/97— -hSfi2_2 <br /> l DRILLER 4DPR%ENTA1h1VE DATE SIGNED C 57 LICENSE NUMBER <br /> UtAR1iiARF� 'wI IF ADDITIONAL SPACE IS NEEDED USE NEXT CONSECUTIVELY NUMBERED FORM I 1 <br />