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r <br /> The free Adobe Reader may be used to view and comple•form. However,software must be purchased to complete, nd reuse a saved form. <br /> e Original with DWR State of California DDM ilea Cv —Do Not Fill In <br /> � <br /> Well Completion Report <br /> Page 1 Of 5 Refer to Instruction Famohlet <br /> Owner's Well Number MW-2 No. e0186771 I c State WeNNumbrer/SiteNumber <br /> lI W <br /> Date Work Began 08/09/2013 Date Work Ended 8/9/2013 Latitude Lon itude <br /> Local Permit Agency San_loaouiin County Environmental Health Department i <br /> Permit Number 67665 Permit Date 7/29113 AP,7RSiOther <br /> Geologic Log Well Owner <br /> Orientation O Vertical O Horizontal OAngle Specify Name Bill Sossamon <br /> Drilling Method Overdrill-Hollow Stem Auger Drilling Fluid Mailing Address 3120 West Hwy 64 <br /> Depth from Surface Description Ozark AR 72949 <br /> Feet to Feet Describe material,grain size,color,etc Cit Slate i <br /> 0 2 Native material Well Location <br /> 2 25 Portland cememt Address Olin Facility-2600 S. Banta Road <br /> City Tracy County San Joaquin <br /> Latitude N Longitude �v <br /> Deo. Min. Sec. Deo. Min. Sec. <br /> Datum NAD83 Dec Lat. 37.7124814 Dec.Long.-121.3795969 <br /> APN Book 252 Page 150 Parcel 08 <br /> Township Range Section <br /> Location Sketch Activity <br /> Sketch must be drawn by hand after torn is printed) L-d.' <br /> ew Well <br /> North Modification/Repair <br /> O Deepen <br /> O Other <br /> [Destroy <br /> Descrprocedures and matermb <br /> -GEOLOGIC LOG" <br /> Planned Uses <br /> O Water Supply <br /> O Domestic ❑Public <br /> 3 w ❑Irrigation ❑Industrial <br /> O Cathodic Protection <br /> O Dewatering <br /> O Heat Exchange <br /> O Injection <br /> Monitoring <br /> O Remediation <br /> O Sparging <br /> South O Test Well <br /> iriusvate or describe dist—of w R from roads.bui4finps.re�ceti O Vapor Extraction <br /> etc and attaU a rep.Use additional paper d necessary O Other <br /> Please be accurate and cpm <br /> Water Level and Yield of Completed Well <br /> Depth to first water (Feet below surface) <br /> Depth to Static <br /> Water Level (Feet) Date Measured <br /> Total Depth of Boring 25 Feet Estimated Yield' (GPM) Test Type <br /> Total Depth of Completed Well 23.5 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 T Material Wall Outside Screen Slot Size Depth from <br /> Surface Diameter Type Thickness Diameter Type if Any Surface Fill Description <br /> Feet to Feet inches Inches Inches Inches Feet to Feet <br /> 0 13 10 Blank PVC Sch.40 4 <br /> 13 23 10 Screen PVC Sch.40 4 Milled Slots 0.020 <br /> Attachments Certification Statement <br /> 7,lSeologic Log I, the and n Ity th his 7port is�?mplete d a cur�te o�te ItEst of my knowledge and belief <br /> Ld Well Construction Diagram Name '^ V-P-1`L rN 2 '� 1 �T �i t L d'�'G <br /> 1:1Geophysical Logs) e�n F o oLr�ettonA Clf M 44T7r1o,Z CA <br /> ❑ Soil/Water Chemical Analyses ass 'c- city ?-0#13 <br /> state jIv/ <br /> Z Other S iTV PG.ArJ A 1�I7Rl1 lT Signed <br /> Attach additional informationif it exists. C-57 tic sed Water well Contractor Date Signed C-57 License Number <br /> D`NP.188 RE's/.112006 IF ADDITIONAL SPACE IS NEEDED.USE NEXT ONSECUTPVEL'(NUMBERED FORM <br />