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ORIGINAL STATE OF CALIFORNIA DAR USE ONLY — DO NOT FILL IN <br /> File with DWR OLL COMPLETION REPOR <br /> Page 2 Of 4 Refer to Instruction Pamphlet STATE WELL N0./STATION NO. <br /> Owner's Well No. MW-2 "0- 726056 <br /> �L <br /> Date Work Regan E'pded 12/14/00 LATITUDE LONGITUDE <br /> . Local Permit Ag R San Joaquin Coun y Env. Health Div. <br /> Permit No. Permit Date APN/TRS/OTHER <br /> 1210 , 700 <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION _(SPECIFY) Name Gene Gabbard Inc. <br /> (�) _VERTICAL HORIZONTAL _ANGLE <br /> DRILLING He A, .O. oX <br /> t <br /> DEPTH FROM METHOD FLUID Mailing S(]dO C$, C <br /> SURFACE DESCRIPTION ICOn e <br /> Ft. to Ft Describe material, grain size, color, etc. CIN STATE Zia <br /> 32 Brown Clay Address Nor W"ki L6WO6 St. <br /> City Stockton <br /> County San Joaquin <br /> APN Book Page Parcel <br /> Township Range Section <br /> Latitude I I NORTH Longitude I I WEST <br /> I DEG, MIN. SEC. DEG. MIN, SEC, <br /> LOCATION SKETCH .ACTIVITY (�) <br /> 1i <br /> NORTH NEW WELL <br /> MODIFICATION/REPAIR <br /> Deepen <br /> — Other(Specify) <br /> I I <br /> DESTROY(Describe <br /> See attached site plan Under"GEOLOGIC Materials <br /> ts' <br /> "GEOLOG eOGJ <br /> PLANNED USES (�) <br /> WATER SUPPLY <br /> Domestic Public <br /> N F Irrigation Industrial <br /> w w MONITORING <br /> TEST WELL <br /> CATHODIC PROTECTION <br /> HEAT EXCHANGE <br /> I DIRECT PUSH <br /> INJECTION <br /> VAPOR EXTRACTION <br /> SPARGING <br /> I I SOUTH REMEDIATION <br /> IZlaatrate or Describe Di.rtanee of Well(m.n Roads,Buildings, <br /> Fences,Rfcers,etc.and rtttrtcll n ntnp Ilse nddttinnnl paper if OTHER(SPECIFY) <br /> necesvVT PLEASE BE ACCURATE&COMPLETE. <br /> ( WATER LEVEL & YIELD OF COMPLETED WELL <br /> DEPTH TO FIRST WATER (FL) BELOW SURFACE <br /> DEPTH OF STATIC <br /> WATER LEVEL (Ft.)&DATE MEASURED <br /> ESTIMATED YIELD ' (GPM) &TEST TYPE <br /> TOTAL DEPTH OF BORING 33 (Feet) TEST LENGTH (Hre)TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL 3 2 (Feet) 'May not be representative of a velli long-te1Tn yield. <br /> DEPTH BORE- CASING (S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE HOLE TYPE FROM SURFACE <br /> TYPE <br /> DIA' >; w ¢o n MATERIAL/ INTERNAL GAUGE SLOT SIZE CE. BEN- <br /> Ft. to F[. (Inches) a GRADE DIAMETER OR WALL IF ANY FILTER PACK <br /> (Inches) THICKNESS (Inches) R. to Ft MENT TONITE FILL <br /> y v LL ) (�) (�) (�) (TYPE/SIZE) <br /> 7 32 8" x PVC 2" sch 4 .01 5 132 1 1 # 2112 <br /> 0 7 8" PVC 2" sch 4 3 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 ra4Carlp Dri11 i na Tnr <br /> Geophysical Log(s) <br /> (PERSON, FIRM, OR CORPORATION) (ttPEO ORP 0) <br /> — <br /> Soil/Water Chemical AnalysesA'A Rancho <br /> Other ADDRESS CITY p-. 5 A ZIP <br /> ATTACH ADDITIONAL INFORMATION, IF IT EXISTS. signs WELL ORIL R/AOTHORIZ EPRESENTATIVE GATE SIGfJCU C-57 LIE N <br /> DAR 188 REEF. 11-e7 IF ADDITIONAL SPACE IS NEEDED, U9f NEXT CONSECUTIVELY NUMBERED FORM <br />