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f <br /> ORIGINAL STATE OF CALIFORNIA DWR USE ONLY — 00 NOT FI IN <br /> File with DWR WELL COMPLETION REPORT 101 <br /> page of Rcfer to Instruction Punt N t�+p STATE WELL NO./ ATION NO. <br /> Owner's Well No. No. 0! 2 6 6 8 I I I I <br /> mate Work Began ~I +`Q 1 Ended 1 r 1 4 LATITUDE LONGITUDE <br /> Local Permit Agency San Joaquin Health Dept. <br /> Permit No. 3 6 4 Pennit Date APN/TRS/OTHER <br /> GEOLOGIC LOG - WELL OWNER <br /> ORIENTATION (IL) X VERTICAL —HORIZONTAL —ANGLE —(SPECIFY) <br /> DRILLING <br /> DEPTH FROM METHOD mud rotary FLUID W a t e r <br /> SURFACE DESCRIPTION <br /> Ft. to Ft. Describe material, grairt .size, color-, etc. <br /> 4 TQps� Address .23569 S.W AnTe `e Ave. <br /> 4 -,- 11 Sand City Riverbank <br /> 11 17 t Sand ravel County San Joaquin <br /> 17 22 Clay APN Book 249 Page 0 7 0 Parcel 12 <br /> 22 54 Sand/gravel Township Range Section <br /> 54 61 Clay Lat _ N Long , _ W <br /> 61 I 72 , Sand r a ve 1 DEG. MIN. $EC. DEG MIN. SEC. <br /> LOCATION SKETCH ACTIVITY (�) <br /> 72 -7 5 Clay NORTH _X_ NEW WELL <br /> 75 96 S a n d/ g r a v e l rocks MODIFICATION/REPAIR <br /> 76 82 , Clay _ Deepen <br /> 82 88 Gravel' — Other(Specify) <br /> 88 96 /C a <br /> 9 6 9 8 1 Gravel DESTROY(Describe <br /> Procedures and Materiels <br /> Under"GEOLOGIC LOG") <br /> 98 120 Clay USES(2:�) <br /> 12 0 122I Sand/gravel WATER SUPPLY <br /> 12 209 1 C l a ravel s t r e a k s r l — Domestic X Indust <br /> y Irrigation — Industrial <br /> 209 , 42 , Clay/sand streaks 3 MONITOflING <br /> 4 243 Sand TEST WELL <br /> 243 249I Clay CATHODIC PROTECTION <br /> S a n g r a v e l HEAT EXCHANGE <br /> I I DIRECT PUSH <br /> I a INJECTION <br /> ' VAPOR EXTRACTION <br /> I SPARGING <br /> 1 SOUTH REMEDIATION <br /> Illustrate or Describe Distance of Well from Roads,Buildings OTHER(SP&CIFY) <br /> Fences,Rivers,etc.alul attach a nmp Use additional jyapes it <br /> ueeessanj.PLEASE BE ACCURATE&COMPLETE. <br /> I , <br /> WATER LEVEL & YIELD OF COMPLETED WELL <br /> DEPTH TO FIRST WATER (Ft.) BELOW SURFACE <br /> I DEPTH OF STATIC <br /> WATER LEVEL 3 4 (FL)&DATE MEASURED <br /> ESTIMATED YIELD ' (GPM)&TEST TYPE <br /> TOTAL DEPTH OF BORING (Feet) TEST LENGTH (His.)TOTAL DRAWDOWN (Ft.) <br /> TOTAL. DEPTH OF COMPLETED WELL —2 5 7 (Feet) `May not be representative of a well's long-term yield. <br /> DEPTH BORE- CASING (S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE HOLE TYPE(-t::) FROM SURFACE TYPE <br /> DIA. x z ' MATERIAL/ INTERNAL GAUGE SLOT SIZE UIET <br /> EN- <br /> (Inches) w a GRADE DIAMETER OR WALL IF ANY NITE FILL FILTER PACK <br /> Ft. to Ft. Ft, to Ft. (TYPE/SIZE(Inches) THICKNESS (Inches) ) <br /> mil 0!) <br /> 0 237 12 PVC 6 SDR17 0 5 6 X <br /> 0 1 200 257 __X sand/aravill <br /> I , <br /> i—' ATTACHMENTS CERTIFICATION STATEMVNT <br /> 1 Geologic Log I,the undersigned,certify that this report is complete and accurate to the best of my knowledge and belief. <br /> Well Construction Diagram NAME Kennings Bros. Drilling C o. , Inc. <br /> (PERSON, FIRM, OR CORPORATION) (TYPED OR PRINTED) <br /> Geophysical Log(s) 3525 P e l a n d a l'e A V e. , Modesto CA 95356 <br /> Soit(Water Chemical Analyses mi <br /> ADDRESS CITY STATE ZIP <br /> Other <br /> ATTACH ADDITIONAL INFORMATION, IF IT EXISTS. Signed 5 1 D fl 4 290813 7 <br /> I L. C-57 CE ED WATER WEII C R DR DATE SIGNED C-5 LICENSE NUMBER <br /> Dwit 188 REv 05-03 IF ADDITIONAL SPACE IS NE ED, USE NEXT CONSECUTIVEL UMBERED FORM OSP 03 78M <br />