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« <br />or Default? <br />from DHS database <br />active from DHS database <br />yes <br />none <br />no <br />5/28/2002Pacific Bell (8 Mile Rd)/Well Data Sheet <br />38.05628365 <br />121.286171 <br />fencing <br />yes <br />to come from DWR <br />to come from DWR <br />from DHS database <br />from DHS database <br />from DHS database <br />from DHS database <br />Date drilled__________________________________________ <br />Drilling Method ___________________________________ <br />Depth of Bore Hole (feet below ground surface)______________ <br />Casing Beginning Depth/Ending Depth(ft below surface); <br />2nd Casing Beginning Depth/Ending Depth; 3rd Casing, etc. <br />Casing Diameter (inches); 2nd Casing Diameter; 3rd Casing, etc. <br />Casing Material; 2nd Casing Material; 3rd Casing, etc. <br />2300 E Eight Mile Rd <br />West Lane <br />_____Stockton_____ <br />San Joaquin County <br />A, Ru <br />yes <br />Latitude____________________________________ <br />Longitude__________________________________ <br />Ground Surface Elevation (ft above Mean Sea Level) <br />Street Address______________________________ <br />Nearest Cross Street_________________________ <br />City_______________________________________ <br />County____________________________________ <br />* Neighborhood/Surrounding Area (see Note 1) <br />Site plan on file? ("YES" or "NO")_______________ <br />DWR Ground Water Basin_____________________ <br />DWR Ground Water Sub-basin_________________ <br />SANITARY CONDITIONS <br />Pacific Bell UE-708 <br />3901086 <br />SJ County files <br />SJ County <br />5/28/2002 <br />well head <br />3901086-001 <br />no <br />0/50; 0/246 <br />16; 10 <br />steel; steel <br />1978 <br />rotary <br />260 <br />_____________________ VEIL DATA SHEET (Page 1 of l_____________________ <br />Complete as much information as possible. Leave blank if information is not available, use N.A. if not applicable. <br />★indicates items required for Source Water Assessment <br />** Indicates additional items required for assessments and Ground Water Rule________________ ______________ <br />(separate multiple entries in Actual, Estimated <br />field with semi-colon) <br />____________DATA SHEET GENERAL INFORMATION_______ <br />System Name_________________________________________ <br />System Number_______________________________________ <br />Source of Information (well log, DHS/County files, system, etc)_____ <br />Organization Collecting Information (DHS, County, System, other) <br />Date Information Collected/Updated________________________ <br />______________well identification__________ <br />* Well Number or Name_________________________________ <br />* DHS Source Identification Number (FRDS ID No.)___________ <br />DWR Well Log on File? ("YES" or "NO")____________________ <br />State Well Number (from DWR)___________________________ <br />Well Status (Active, Standby, Inactive)______________________ <br />WELL LOCATION <br />** Distance to closest Sewer Line, Sewage Disposal, Septic Tank (ft) <br />Distance to Active Wells (ft)_______________________________ <br />Distance to Abandoned Wells (ft)___________________________ <br />Distance to Surface Water (ft)_____________________________ <br />** Size of controlled area around well (square feet)_____________ <br />* Type of access control to well site (fencing, building, etc)_______ <br />* Surface Seal? (Concrete slab)("YES", "NO" or "UNKNOWN") <br />* Dimensions of concrete slab: Length(ft)/ Width(ft)/ Thick(in) <br />* Within 100 year flood plain? ("YES", "NO" or "UNKNOWN") <br />* Drainage away from well? ("YES" or "NO")__________________ <br />__________________ENCLOSURE/HOUSING_______________ <br />Enclosure Type (building, vault, none, etc.)___________________ <br />Floor material__________________________________________ <br />Located in Pit? ("YES" or "NO")____________________________ <br />Pit depth (feet) (if applicable)______________________________ <br />WELL CONSTRUCTION