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R��� <br /> L <br /> ' ,,;, I <br /> OF eialNAL U ATE OF CALIFORNIA DWR USE ONLY — DO NOT FILL IN <br /> File with DWR �LL COMPLETION REPOR <br /> JAN Refer to Iestruction Paur filet STATE WELL NO./STATION NO. <br /> Page'of 4 9 2001 f P ❑�❑ <br /> Owner's Well No. MW-1 No 7/��O <br /> Date Work Began 12/13 �}fi�lT HEFT. N 4/00 L LATITUDE LONGITUDE <br /> Local Permit A ency San o_ plly$ �j + Env. Health Div. <br /> SR# 0024710 12/01 /00 APN/TRS/OTHER <br /> Permit No. Permit Date <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION (i ) —'y VERTICAL _HORIZONTAL _ANGLE _(SPECIFY) Name Gene Gabbard Inc. <br /> DRILLING H.S.A. P.O. Box 1260 <br /> METHOD FLUID Mailing Address <br /> DEPTH RFACEM DESCRIPTION Stockton, CA 95212 <br /> Ft. to Ft Describe material, grain size, color, etc. CITY STATE ZIP <br /> WELL LOCATION <br /> 0 32 Brown Clay Address 640 North P.1 norarIn Rt <br /> City Stnektnn <br /> Cour San Joaquin <br /> APN Book Page Parcel <br /> TownsLip Range Section <br /> Latitude I I NORTH Longitude I I WEST <br /> DEG, MIN. SEC. DEG. MIN. SEC. <br /> LOCATION SKETCH ACTIVITY (�1 <br /> NORTH _X NEW WELL <br /> ' MODIFICATION/REPAIR <br /> — Deepen <br /> Other(Specity) <br /> I I <br /> See attached site plan DESTROY(Deecrtbe <br /> Procedures and Materials <br /> Under"GEOLOGIC LOG") <br /> ' PLANNED USES ('—') <br /> r WATER SUPPLY <br /> _ Domestic Public <br /> F FIrrigation Industrial <br /> ' 3 W MONITORING <br /> r TEST WELL <br /> CATHODIC PROTECTION <br /> HEAT EXCHANGE— <br /> DIRECT PUSH <br /> INJECTION <br /> VAPOR EXTRACTION <br /> SPARGING <br /> SOUTH REMEDIATION_ <br /> Millions,or Describe Distance of Well(rant Reade,Buildings, <br /> Fences,Ricers,de.and attach a nmp Use additional paper if OTHER(SPECIFY)_ <br /> necessany.PLEASE BE ACCURATE&COMPLETE. <br /> WATER LEVEL & YIELD OF COMPLETED WELL <br /> I I <br /> DEPTH TO FIRST WATER (Ft.) BELOW SURFACE <br /> DEPTH OF STATIC <br /> WATER LEVEL (FL)8 DATE MEASURED <br /> ESTIMATED YIELD ' (GPM)a TEST TYPE_ <br /> TOTAL DEPTH OF BORING 33 (Feet) TEST LENGTH (Hrs.) TOTAL DRAWDOWN (Ft) <br /> TOTAL DEPTH OF COMPLETED WELL, 32 (Feet) May not be representative of a well's hmg-term yield. <br /> DEPTH CASING (S) DEPTH ANNULAR MATFRIAI, <br /> FROM SURFACE BORE- TYPE(�) FROM SURFACE TYPE <br /> HOLE <br /> DIA. m w ¢ ii MATERIAL/ INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> (Iheres) 5 lo oP r1 GRADE DIAMETER OR WALL IF ANY MENT TONITE FILL FILTER PACK <br /> Ft to Ft. oo LL (Inches) THICKNESS (inches) FL to FL TYPE/SIZE) <br /> 7 1 32 8" PVC 2" sch 40 . 01 5 132 #2 12 <br /> 0 7 8" x PVC 2" sch 40 3 1 5 x <br /> 0 ' 3 x <br /> I <br /> ATTACHMENTS (2e) CERTIFICATION STATEMENT <br /> Geologic Log I,the undersigned,certify that this report is complete and accurate to the best of my knowledge and belief. <br /> • _ <br /> Well Construction Diagram NAME Cascade Drilling, Inc. <br /> Geophysical Log(S) (PERSON, FIRM, OR CORPORATION) (TYPED OR PRINTED) <br /> — <br /> Soil/WaterChemicalAnalyses 3632-Qme_c Circle Rancho Cordova CA 95742 <br /> Other ADDRESS Cltt STAT ZIP <br /> ATTACH ADDITIONAL INFORMATION, IF IT EXISTS. Signed I S-� 717510 <br /> ILLER/ IZED REPRESENTATIVE DATE SIGNED C-57 LICENSE NUMBER <br /> DWR 188 REP. a=r IF ADDITIONAL SPACE IS NEEDS , USE NEXT CONSECUTIVELY NUMBERED FORM <br />