Laserfiche WebLink
Geologic Log Well Owner <br />°Angle Specify <br />Drilling Fluid BentoniW mud <br />Orientation €) Vertical 0 Horizontal <br />Drilling Method mud rotary <br />City Ripon State CA 7ip 95366 <br />County San Joaquin City Ripon <br />N Longitude Latitude --VV <br />Deo, Min. Sec. Deo. Min. Sec, <br />Datum Dec. Lat. Dec. Long. <br />APN Book 203 Page 110 Parcel 10 <br />Range Section Township <br />Location Sketch Activity <br />Total Depth of Boring 280 Feet <br />Total Depth of Completed Well 240 Feet <br />Casings <br />*The tree Adobe Reader may be used to view and complete this form. However, software must be purchased to complete, save, and reuse a saved form. <br />File Original with DVVR <br />Page of <br />Owners Well Number <br />Date Work Began 09/12/2017 <br />Local Permit Agency San Joaauin <br />Permit Number 37172 <br />DVVR Use Only — Do Not Fill In <br />J I 1 l 1 1 I <br />State Well Number/Site Number <br />I I I N IIII I I' <br />Latitude Longitude <br />11111 IIIIIII <br />APN/TRS/Other <br />State of California <br />Well Completion Report <br />Refer to Instruction Pamphlet <br />No. e0355639 <br />Date Work Ended 9/21/2017 <br />Health DeDt. <br />Permit Date <br />Name Marlene Coonce <br />Mailing Address P.O. Box 660 <br />Well Location <br />Address 15127 French Camp Rd. <br />®New Well o Modification/Repair 0 Deepen <br />0 Other <br />0 Destroy <br />Dasarbe procedure* and matenals <br />under 'GEOLOGIC LOG' <br />Planned Uses <br />C) Water Supply <br />0 Domestic ID Public <br />0 Irrigation El Industrial <br />0 Cathodic Protection <br />0 Dewatering <br />Heat Exchange <br />Injection <br />Monitoring <br />Remediation <br />Sparging <br />0 Test Well <br /> • 0 Vapor Extraction <br />0 Other <br />ater Level and Yield of Completed Well <br />Depth to first water (Feet below surface) <br />Depth to Static <br />Water Level 62 (Feet) Date Measured <br />Estimated Yield • (GPM) Test Type <br />Test Length (Hours) Total Drawdown (Feet) <br />'May not be representative of a well's long term yield. <br />Annular Material <br />quik grout 108 0 8 .322 <br />No 6 sand pack 240 0.050 108 .322 8 <br />Depth from <br />Surface <br />Feet to Feet <br />Borehole <br />Diameter <br />(Inches) <br />Wall Outside <br />Thickness Diameter <br />(Inches) (Inches) <br />Slot Size <br />If Any <br />((nches) <br />Depth from <br />Surface Fill Description <br />Feet to Feet <br />Screen <br />Type <br />0 200 14 Blank PVC <br />200 240 14 screen PVC <br />Type Material <br />Attachments <br />CI Geologic Log <br />0 Well Construction Diagram <br />0 Geophysical Log(s) <br />1:1 Soil/Water Chemical Analyses <br />0 Other <br />Attach additional information, if it exists <br />DWR 188 REV. 112006 <br />Certification Statement <br />I, the undersigned, certify that this report is complete and accurate to the best of my knowledge and belief <br />Name Hennings Bros. Drilling Co..InC. <br />Person. Firm or Corporation <br />1930 Ladd Rd. Modesto <br />...., <br />Signed <br /> ,zAdd7rss,/Ldir.." City <br />/ aelz,tc 'J., .44/ - 10/23/2017 <br />C-57 censed Water Well COtractor - / Date Signed <br />IF ADDITIONAL SPAE IS NEEDED, USE NEXT CONSEC ELY NUMBERED FORM <br />CA 95356 <br />State Zip <br />290813 <br />C-57 License Number <br />(Sketch must be drawn by hand after fomi is printed.) <br />North <br />co Lu <br />South <br />Illustrate or describe distance of well from roads, buildings, fences, <br />rivers. err end each a map. Use addilional paper if necessary. <br />Neese be accurele and complete. <br />Depth from Surface <br />Feet to Feet <br />0 4 <br />4 6 <br />6 16 <br />16 28 <br />28 70 <br />70 130 <br />130 147 <br />147 157 <br />157 190 <br />190 194 <br />194 201 <br />201 210 <br />210 221 <br />221 235 <br />235 240 <br />240 256 <br />256 259 <br />259 274 <br />274 280 <br />Description <br />Describe material, grain size, color, etc <br />sand <br />hardpan <br />sand <br />clay <br />sand <br />clay <br />sand <br />clay <br />sand <br />clay <br />sand <br />clay <br />sand <br />fine sand with clay streaks <br />sand <br />clay <br />sand <br />clay <br />sand w/clay streaks