ARCHIVED REPORTS_2009_16 - Laserfiche WebLink

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*The free Adobe Reader may be used to view and complete this form. However,software must be purchased to complete,save,and reuse a saved form. File Original with DWR State of California DWR Use Only-Do Not Fill In Well Completion Report Page 3 of 3 Refer to Instruction Pamphlet Owner's Well Number AMW-23 No. e0084071IN]State Well Number/Site 1 Number W 0 o Work Began 11/18/2008 Date Work Ended 11/20/2008 Latitude Longitude cal Permit Agency San Joaouin County Permit Number SR#0055551 Permit Date 10/22/08 APN/TRS/Other Geologic` L2g Well Owner Orientation O Vertical O Horizontal OAngle Specify Name Forward Incorporated Drilling Method Mud Rotary Drilling Fluid Mud Depth from Surface Description Mailing Address 9999 S.Austin Road Feet to„ Feet Describe material,grain size,color,etc City Manteca State CA__Zip 95336 165.0 170.0 SAND and GRAVEL,fine grained sand thru Well Location med.gravel,angular gravels Address w/in 1500'West of Austin Road 170.0 170.6 SAND and GRAVEL,coarse grained sand to City Stockton County San Joaquin fine sub-angular gravels,wet multi-colored Latitude 37 53 39.30 N iLongitude -121 11 21.58w 170.6 175.0 SAND and GRAVEL Dec. Min. Sec. Dea. Min Sec. 175.0 180.0 SAND and GRAVEL Datum WGS84 Decimal Lai. 37.894 Decimal Long.-121.189 180.0 185.0 SAND, med-coarse grained, multi-colored APN Book 181 Page 150 Parcel 11 185.0 186.4 CLAY, moist,soft,some fine gravels within Townshi 1 North Range,7 East Section 34 5 PB 5/2 Lbdatlon Sketch Activit sketch must be drawn by hand after form isprinted.) Q New Well North O Modification/Repair O Deepen O Other - 0 Destroy Describe procedures and materials under"GEOLOGIC LOG" Planned.Uses Q Water Supply [:]Domestic ❑Public w []irrigation ❑Industrial O Cathodic Protection O Dewatering O Heat Exchange O Injection E) Monitoring O Remediation O Sparging South O Test Well Illustrate or describe distance of well from roads,buildings,fences, O Vapor Extraction rivers,etc.and attach a map. Use additional paper if necessary. O Other Please be accurate and complete Water Level and Yield of Com Ieted.Well,. Depth to first water N/A (Feet below surface) Depth to Static Water Level 69.77 (Feet) Date Measured 12/08/2008 Total Depth of Boring 185 Feet ***See Estimated Yield* N/A (GPM) Test Type N/A Note at Test Length N/A (Hours)Total Drawdown N/A (Feet) Total Depth of Completed Well 185 Feet Bottom *May not be representative of a well's long term Xield. 'Casings �; � '� �_ Annular Material Depth from ` Borehole Type Material Wall Outside Screen Slot Size Depth from Surface Diameter Yp Thickness Diameter Type if Any Surface Fill Description Feet to Feet inches Inches Inches Inches Feet to Feet 0 159 8 Blank PVC Sch.80 0.218 2.375 NIA N/A 0 150 Concrete Quickrete Concrete 159 184 8 Screen PVC Sch.80 0.218 2.375 PVC 0.010 150 154 Bentonite Pel-Plug Bentonite Pellets 159 184 Sane 2/12 Cemex Lapis Lustre Sand Attachments Certficatlon Statement El Geologic Log i,the undersigned,certify that this report is complete and accurate to the best of my knowledge and belief El Well Construction Diagram Name Dave Vasbinder Herst&Associates Inc. ElGeoph Geophysical LO S Person,Firm or Corporation Y Log(s) 4630 S. Hwy 94-N.Outer Road Saint Charles MO 63304 El Soil/Water Chemical Analyses ares city State zip ❑Other Signed I—(S-C1 636387 Attach additional information Hit exists. 11 C-57 Licensed Water Well Contractor Date Signed C-57 License Number ***Drilling depth scale begins at one foot above ground surface due to required drilling rig setup.