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<br /> File Original with DWR State of California DWR Use Only—Do Not Fill In
<br /> Page 1 of 1 Well Completion Report �-
<br /> Rererfo Instruction Pamphlet
<br /> Owner's Well Number KI-19 No. e0215313 State Well Number/Site Number
<br /> Date Work Began 04/27J2014 Date Work Ended 4/23/2014 Latitude
<br /> Local Permit Agency San Joaquin EnvironmQnlgl H Irl,[)apartment
<br /> Permit NumberR#69242 SPermit Date 3/17/14 ,APNrrRS/Otherl 1 I 1 t
<br /> Geologic Log Well Owner
<br /> Orientation O Vertical O Horizontal OAngle Specify- Name Keamev National. Inc.
<br /> Dolling Method mud rota Drilling Fluid drilling mud
<br /> Depth from Surface Mailing Address 565 Fifth Avenue,4th Floor
<br /> P Description
<br /> Feet to Fast Describe material,grain size color,etc City New York State NY 10017
<br /> 5 5 Fine sandy silt,trace clay, moist,very dark gray- Well Location
<br /> brown, loose Address 1624 East Alpine Ave
<br /> 12 12 Silty sandy day,cemented silt,compressible clayn City Stockton County San Joaquin
<br /> trace medium to coarse sand, brown Latitude 37 59 0 N Longitude 121 16 50
<br /> 23 23 Well graded medium to coarse gravel,trace fines, deo Mm. Sec. Dec, Mm. s«,
<br /> dark brown,angular multicolored fragments,loose Datum NA083 Dec.Lat. 37.983462 Dec.Long.-121.280709
<br /> 33 33 Clayey,silty fine sand,compressible,cohesive p APN Book Page Parcel 11708006
<br /> clay,cemented silts,yellowish-brown Township 02N Range 06E Section 35
<br /> 45 45 Clayey,silty fine sand,trace coarse,angular sand, Location Sketch Activity
<br /> compressible clay,cemented silts,yellowish-brove j5ae must be dra n by hand a rfortn is pnnted. Q New Well
<br /> North Q Modification/Repair
<br /> 50 50 Clayey,silty fine sand,trace medium,trace O Deepen
<br /> angular gravel,cemented silts,yellowish-brown O Other
<br /> 60 60 Silty, clayey fine to medium sand,angular white O Destroy
<br /> tx.u;m pmcadUma end matm.is
<br /> gravels, cemented silts,compressible clay, undm cEoLocio Loc'
<br /> yellowish-brown Planned Uses
<br /> 70 70 same as 60 feet O Water Supply
<br /> 80 80 Clayey,sandy silt,cemented silts,trace medium RECEIVED.. ❑Domestic Public
<br /> ❑Irrigation ❑Industrial
<br /> w
<br /> sand,dark yellowish-brown,some reddish-brown 3 Q Cathodic Protection
<br /> oxidized grains,compressible clay JUN 19 2014 O Dewatering
<br /> 90 90 Silty fine t0 medium sand,trace day,cemented O Heat Exchange
<br /> silts,yellowish-brown O Injection
<br /> 100 100 Silty fine sand with clay,trace medium,cementedp ENVIRONMENTAL HEALTH O Monitoring
<br /> silts,yellowish-brown PERMIT/SERVICES O Remediation
<br /> 104 105 Sand lens,well graded,predominantly fine to O Sparging
<br /> medium sand,trace coarse,trace clay, South O Test Well
<br /> wuahme aaa:eae a.ana m.,ar rte.mads,balm, ranaa. O Vapor Extraction
<br /> yellowish-brown,loose meas etc,andaacha mep.the aaamaai waaanec�essar. QOther
<br /> 106 118 Silt and clay,trace sand,plastic,compressible, masa ba.am„m,ad Baa aa.
<br /> cohesive,grayish-brown ater Level and Yield of Completed Well
<br /> 118 119 Sand lens,fine to medium sand,trace silt and clay Depth to Static
<br /> Depth to first water (Feet below surface)
<br /> 119 120 Silt and clay,trace sand Water Level 47 (Feet) Date Measured 05/12/2014
<br /> Total Depth of Boring .120 Feet Estimated Yield' (GPM) Test Type
<br /> Total Depth of Completed Well 107 Feet Test Length (Hours) Total Drawdown_(Feet)
<br /> -may not be representative of a well's long term yield.
<br /> Casings Annular Material
<br /> Depth from Borehole Type Material wall Outside Screen Slot Size Depth from
<br /> Surface Diameter Thickness Diameter T
<br /> Feet to Feet Inches Type if Any Surface Fill Description
<br /> Inches Inches Feet to Feet
<br /> 0 102 110 Blank PVC Sch.80 4 0 13 Concrete surface seal
<br /> 102 107 10 screen PVC Sch.eo 4 1 Milled Slots 10.020 3 93 Cement sanitary seal
<br /> 93 98 Bentonite bentonite pellets
<br /> 98 100 sand fine transifion sand
<br /> 100 113 Fitter Pack No.3monterey
<br /> 113 120 Bentonfte bentonite pellets
<br /> Attachments 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 /> ❑O Well Construction Diagram Name Dudek/Gregg Drillin l
<br /> ❑Geophysical Lo s Person,Firm or Corporation
<br /> 13 Soil/Water Chemical Analyses
<br /> 9O 605 Third Street Encinitas CA 92024
<br /> O Other well location figure Signed damns C✓/g S / �o�'
<br /> AtUch additional information if it exists. C11 ET aterwall Contra DWSidned C-57 License_Number
<br /> DNR 188 REV.12006 IF ADDITIONAL SPACE IS NEEDED,USE N NSECUTIVELY NUMBERED FORM
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