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ORIGIWAL STATE OF CALIFORNIA DWR USE ONLY — DO NIT FILL IN <br /> file with DWR WELL COMPLETION REPORT <br /> Nrf•r to lncrr„ethm Pamphlo STATE WELL NO/S ATION NO. <br /> Pogo_of—____ <br /> .►cr' 7 '�Q/O 4 Well No. ( Na e016162 ❑ <br /> LATITUDE LONGITUDE <br /> Work Began Ended <br /> Loc;J Permit Agent San Joaquin Health Dept. <br /> Permit No. 9 Permit Date APNITRS/OTHER <br /> GEOLOGIC LOG ��rr•• n�.rvco <br /> ORIENTATION (.Z' .�.VERTICAL _HORIZONTAL _ANGLE (SPECIFY) <br /> DRILLING <br /> DEPTH FROM METHOD FLUID <br /> SURFACE DESCRIPTION <br /> Ft to PL Describe material,grain size, color-, Or. "' -' <br /> 11 LL OCA ON <br /> Address 23569 S. an e Aye. <br /> Abandon old 6"x701 steel City Riverbank <br /> I casing well County an Joaquin <br /> APN Book 2 4 9 Page 10 7 0 P;u-c•et 12 <br /> Line a S e n g Township Range Section <br /> ery t <br /> Latitlulc I I NORTH L,ongitudc I I WEST <br /> OEG. MIN. SEC. DEC MIN. SEC. <br /> LOCATION SKETCH ACTIVITY (�} <br /> with 10 .3 sack mix , sandNORTH <br /> NEW WELL <br /> MODIFICATION/REPAIR <br /> Daepen <br /> I I <br /> with cement pumper —Other(Specfly) <br /> DESTROY(Describe <br /> Procedulea end Materials <br /> Under"GEOLOGIC LOG'J <br /> PLANNED USES (2�) <br /> WATER SUPPLY <br /> Dom ubt Public <br /> r � eNon Induslnal <br /> w MONITORING_ <br /> TEST WELL <br /> I CATHODIC PROTECTION <br /> HEAT EXCHANGE <br /> f DIRECT PUSH_ <br /> INJECTION <br /> ' VAPOR EXTRACTION_ <br /> SPAROING <br /> SOUTH Re VEDIATION <br /> fU ntrate or l)emrrlbe Dlowur(I)`IYrll from&IwA.Bnildln", <br /> Fencer,Ricci,,err.and orfnrh❑um l Vic additianrll rgmr if OTHER(SPECIFYI— <br /> nrenunry.PLEASE BE ACCURATE&COd1PLET . <br /> WATER LEVEL & YIELD OF COMPLETED IVE,1.1, <br /> I I <br /> DEPTH TO FIRST WATER (FL) BELOW SURFACE <br /> DEPTH OF STATIC <br /> WATER LEVEL (Ft.)6 DATE MEASURED <br /> ESTIMATED YIELD ' (GPM)d TEST TYPF <br /> TOTAL DEPTH OF BORING (Feet) TEST LENGTH (H,e.)TOTAL DRAWDOWN (FI.) <br /> TOTAL DEPTH OF COMPLETED WELL (Feet) Alay not be represeuratiae ora--,ells long-rmn;,&l. <br /> DEPTH CASING (S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE HORS TYPE FROM SURFACE TYPE <br /> DIA. Y3 i MATERIAL/ INTERNAL, GAUGE SLOT SIZE CE BEN• <br /> pnchos) ] w S GRADE DIAMETER OR WALL IF ANY MENT TONITEFFIL1 FILTER PACK <br /> R, to Ft m ' (Inches) THICKNESS (Incnae) Ft. to Ft. (TYPE/SIZE) <br /> (�) (am) ) <br /> I , <br /> I <br /> I 1 <br /> 1 I <br /> I <br /> ATTACHMENTS (zL) CERTIFICATION STATEMENT <br /> Geologic Log ,the undersigned,certify that this report is complete and accurate to the best of my knowledge and belief. <br /> • _ <br /> _ Well Construction Diagram NAME H e n n i n g S Bros. Drilling C o. . I n c . <br /> (PERSON, FIRM. OR CORPORATION) (TYPED OR PRINTED) <br /> _ GeophysicalLog(s) 3525 Pelandale Ave . Modesto CA 95356 <br /> ScillWater Chemical Analyses <br /> ADDRESS CITY STALE LP <br /> _ Othor /L <br /> AT TACH ACW 110NAL INFORMA 110N, IF 1T EXISTS. �yf1ed L 10/2 5/D 4 290813 <br /> Wtll DRILLER/AUTHORIZED REPRESS TWE DATE SIGNED Gil LICENSE NLMBER <br /> DWII Inn RSA. r-ss IF ADDITIONAL SPACE IS NEEDED, USE NEXT CONSECUTIVEL LIMBERED FORM <br />