Laserfiche WebLink
'The free Adobe Reader may be used to view and complete\-..lform. However,software must be pu-chased to comp t:e,saw 11- l reuse a saved form. <br /> File Original with DWR State of California _ DWR Use Only-Do Not Fill I <br /> Well Completion Report C .- 1— 1 <br /> Page 1 Of 1 Refer to Instruction Pamphlet State Well Number/Site Number <br /> Owner's Well Number MW-4 No. e0239321 1 = N L�=�� <br /> Date Work Began 08/25/2014 Date Work Ended 9/4/2014 - <br /> Agency Latitude Longitude <br /> Local Permit A SCn+.e 1="tar^r,manfal Health Deoartment Com. <br /> 9 Yan oagu^ ouAPN/TRS/Other <br /> Permit Number 70176 Permit Date 6/30/14 <br /> Geologic Log Well Owner <br /> Orientation OVertical O Horizontal OAngle Specify Name San Joagit n County <br /> Drilling Method Hollow Stem Auger Drilling Fluid Mailing Address_:1 D BOK 1810 <br /> Depth from Surface Description Stockton State_CA _Zip 95201 <br /> Feet to Feet Describe material rain size,color,etc Cit' � <br /> 60 0 Overdrill 2" __ Well Location <br /> Address 2662�,,V�isc n Way <br /> City Stockton County San Joaquin <br /> La:itude N Longitude <br /> Deq. Ain.•• Sec. Deq. Min. Sec. <br /> Datum Dc c. "at. 37.982692 Dec.Long.-121.271377 <br /> APN Book 117 ,-_ Fage 060 Parcel 33 <br /> Township Section <br /> Loci t lo i 1?ketch Activit <br /> 3kelch must be dra r r JD ha:d after form is rinsed. O New Well <br /> :.N.irtt O Modification/Repair <br /> O Deepen <br /> O Other <br /> Q Destroy <br /> Describe procedures and materials <br /> under'GEOLOGIC LOG <br /> Planned Uses <br /> O Water Supply <br /> []Domestic DPublic <br /> Of ❑Irrigation Dlndustrial <br /> O Cathodic Protection <br /> O Dewatering <br /> O Heat Exchange <br /> O Injection <br /> 0 Monitoring <br /> O Remediation <br /> O Sparging <br /> S wtt O Test Well <br /> Illustrate or describe distar t e of t ell-i�m roads,buildings,fences, O vapor Extraction <br /> rive ro,etc.and attach a mi 1 Us t ado itional paper if necessary. O Other <br /> Please be accurate and c:rrole to. <br /> ater Level anal`'ie d of Completed Well <br /> Depth to first wa::r__• (Feet below surface) <br /> Depth to Static <br /> Water Level _..__._(Feet) Date Measured <br /> Total Depth of Boring 60 Feet Estimated Yield ' __. (GPM) Test Type <br /> Total Depth of Completed Well 60 Feet <br /> Test Length (Hours) Total Drawdown (Feet) <br /> 'May not be reps :se it£I:tve of a well's long term yield. <br /> Casings Annular Material <br /> Type Material <br /> Depth from Borehole wall Outside Screen Slot Si::: _:lepth from <br /> Surface Diameter Thickness Diameter Type if Any Surface Fill Description <br /> Feet to Feet Inches inches Inches Inche: Feet to Feet <br /> Attachments Certific:i:ic n:statement <br /> D Geologic Log I,the undersigned,certify that this report is comp•ate and accurate to the best of my knowledge and belief <br /> D Well Construction Diagram Name Al well Abandonment inc. <br /> Person,Firm or Corporation .� <br /> D Geophysical Log(s) 3369 Fitzgerald Road,Swi#e� -i raTo Cordova CA 95742 <br /> D So l/Water Chemical Analyses AdcUaes ,• City Stale zip <br /> D Other Site Mai) Signed _ _ 10/31/2014 848359 <br /> Attach additioral information f it exists. C'- C- JI •yCa� e,,, nt ctor� .._ Date Signed C-57 License Number <br /> DWR 188 REV.1/2006 IF ADDITIONAL SPACE IS NE fib.USE NEXT CONSECUTI',E LY NL IABERED FORM <br />