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XR, ILICATE STATE OF CALIFORNIA — D W R USE ONLY—DO NOT F i L I N— <br />'JN ;er's Copy WELL COMPLETION REPORT I I I I I I I I I <br />Page_ of Refer to Instruction Pampblet STATE WELL NO./STATION NO. <br />Owner's Well No. No. <br />Date Work Began N o V . 2 . 1 9 94 Ended Dec. 2 , 1 ;) .[t6 0 7 6 7 LATITUDE LONGITUDE <br />1 �f Local Permit Agency_ San Joaquin C o. Health Dept. <br />I I I I I I I I I I I I I <br />Permit No. 4 3% 5 Permit DateAPN/TRS/OTHER <br />U <br />GEOLOGIC LOG <br />; Cla <br />y <br />ORIENTATION (`! ) <br />VERTICAL _ HORIZONT��AL�� _ ANGLE _ (SPECIFY) <br />11 <br />DEPTH TO FIRST WATER 43 (Ft.) BELOW SURFACE <br />DEPTH FROM <br />18 <br />SURFACE <br />DESCRIPTION <br />I. to Ft. <br />Describe material, grain size, color, etc. <br />U <br />; 9 <br />; Cla <br />y <br />; 11 <br />T San <br />11 <br />; 18 <br />Cla <br />18 <br />26 <br />San <br />6 <br />44 <br />I Blu <br />44 <br />A6: <br />' San <br />46 <br />52 <br />; C I a <br />52 <br />55 <br />San <br />55 <br />; 89 <br />C I a <br />89 <br />A i <br />; San <br />71 <br />1 IUtb <br />Vldy <br />102 <br />110 <br />110 <br />169Clay; <br />Sand <br />Clay <br />:169 <br />184 <br />Sand <br />184 <br />188 <br />Clay <br />188 <br />; 200 <br />Sand <br />200 <br />235 <br />; Clay <br />235 <br />:256 <br />Fine <br />256 <br />:285 <br />Clay <br />285 <br />:295 <br />Sand <br />295 <br />:340 <br />Clay <br />100 ; 205 <br />I <br />I <br />I <br />24" <br />; <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br />WELL OWNER <br /> <br /> <br /> <br /> <br /> <br />WELL LOCATION <br />Address 3919 French Camp Rd. <br />city French Camp/Lathrop Area <br />('otlllty. San Joaquin <br />APN Book Page Parcel <br />Township Range Section <br />or <br />Latitude I I NORTH Longitude WEST <br />DEG. MIN. SEC. DEG. MIN. SEC. <br />LOCATION SKETCH ACTIVITY (� )— <br />NORTH — NEW WELL <br />MODIFICATION /REPAIR <br />\ _ Deepen <br />_ Other (Specify) <br />l <br />t- C <br />W <br />W <br />3 W <br />and & Clay Streaks <br />'TOTAL DEPTH OF BORING 340 (Feet) <br />TOTAL DEPTH OF COMPLETED WELL 205 (Feet) <br />SOUTH <br />Illustrate or Describe Distance of Well from Landmarks <br />Stich as Roads, Buildings, Fences, Rivers, etc. <br />PLEASE BE ACCURATE & COMPLETE. <br />DESTROY (Describe <br />Procedures and Materials <br />Under "GEOLOGIC LOG". <br />-PLANNED USES) <br />MONITORING <br />WATER SUPPLY <br />Domestic <br />X Public <br />_ Irrigation <br />Industrial <br />— "TEST WELL" <br />— CATHODIC PROTEC. <br />TION <br />_ OTHER (Specify) <br />DRILLING Reverse. Rottry Bentonite/Water <br />METHOD FLUID <br />WATER LEVEL & YIELD OF COMPLETED WELL <br />DEPTH OF STATICS E E <br />WATER LEVEL /.t Ft.) & DATE MEASURED <br />ESTIMATED YIELIRTTACHE pM) & TEST TYPE <br />TEST LENGTH (Hrs.) TOTAL DRAWDOWN (Ft.) <br />' May not be representative of a well's long-term yield. <br />DEPTH <br />FROM SURFACE <br />BORE- <br />HOLE <br />DIA. <br />(Inches) <br />CASING(S) <br />DEPTH <br />FROM SURFACE <br />ANNULAR MATERIAL <br />TYPE ✓ y y y <br />ERNIIL GAUGE SLOT SIZE <br />x W o d MATERIAL/ DIAMETER OR WALL IF ANY <br />U GRADE (Inches) THICKNESS (Inches) <br />m <br />TYPE <br />CE-FT'011iEFILTER PACK <br />MENTILL (TYPE/SIZE) <br />°) <br />Ft. to Ft. <br />Ft. to Ft. <br />0 163 <br />24" <br />Stee <br />12.' <br />6' <br />163 8 <br />24" <br />X <br />Stee <br />12 ' <br />1 G ' <br />ul Flo <br />100 ; 205 <br />X Roafi Graver <br />203 ;205 <br />24" <br />K I I <br />ISteel <br />12" <br />3/16-0 <br />; <br />0 109 <br />x <br />PVC <br />4" <br />; <br />I <br />I <br />A-CTAGHMENTS (- ) <br />— Geologic Log <br />— Well Construction Diagram <br />Geophysical Log(s) <br />Soil/Water Chemical Analyses <br />Other <br />ATTACH ADDITIONAL INFORMATION. IF /T EXISTS. <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) (TYPED OR PRINTED) <br />352.5 PELANDALE AVE. MODESTO CA 95356 <br />1::AA Y �� <br />Signed ..,r...... <br />DEC.14,1994 290813 <br />DWR 188 REV. 7.90 IF ADDITIONAL SPACE IS NEEDED, USE NEXT CONSECUTIVELY NUMBERED FORM <br />