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ORIGINAL * STATE OF CALIFORNIA ! DWR USE ONLY-DO NOT FILL IN <br /> File with DWR WELL COMPLETION (�Y� ��/J���'� <br /> Page 1 Of 1= _ Refer to Instruction Pam I ( �C v U STATE WELL NOISTATION NO <br /> ..West <br /> Owner's Well Number MVV-19 e0013617 <br /> -- - - ---_. -_. <br /> Date Wurk Began 05i i4iO4. EndedO5114104 May 28,2004 JUN 0 1 2004 LATITUDE LONGITUDE <br /> Local Permit AUency San Joaquin County APN Book Page Pared <br /> Permit No.SKuuiiayti Permit Date 05M 3/2004 FNVIRMA <br /> Nil (QFC APN/TRS/OTHER <br /> Orientation Vertical <br /> Geologic Log Name fJJew Vt�Petl WPP <br /> Drilling Method Hollow Stem Auger Fluid Mailing Address 1831 16th Street <br /> Depth From Sacramento California 95245 <br /> Surface Description Well Location ; <br /> Feet to Feet Describe general material,gain c¢e,color,am. Address 6437 West Banner Avenue f <br /> 0-5 Fill City Lodi i <br /> 5-21 Sandy Silty County San Joaquin County <br /> 21 -26 Silty Sand APN Book Page Parcel <br /> 26-36 Silty Township Range <br /> west <br /> 36-50 Sand <br /> Location Sketch Activity <br /> North New:vNl <br /> Planned Use <br /> i Monitoring <br /> Ul N <br /> 3 w <br /> South <br /> ustate or Desente Defence of~Aran Roads,Buildups <br /> Fences.Riga;e1c.and afach a map. Uae additimel papa-e <br /> necessary PLFASE BE ACCURATE AND COMPLETE <br /> Water Level and Yield of Completed Well <br /> Depth to First Water <br /> Depth to Static Water Level Date Measured <br /> Estimated Yield' Test Type <br /> Total Depth of Boring 50 Feet Test Length Total Drawdown <br /> Total Depth of Completed Well 50 Feet 'May be representa#se of weirs Aorg term ylekl <br /> Casing Annular Material <br /> Depth from 0LE Material/ Internal GaugeMall Slat Size, Depth from TYPE <br /> Surface OL TYPE Grade Diameter Thickness it any Surface Fitter Pack <br /> DIkFeet to Feet (In.) (In.) (In.) Feet to Feet (TYpersua) <br /> 0-10 10 Blank PVC 2.00 40.00 0-6 Cement <br /> 10-25 10 Screen PVC 2.00 40.00 0.02 6-8 Bentonite <br /> 25-45 10 Blank PVC 2.00 40.00 8-26 Fill #3 <br /> 45-50 10 Screen PVC 2.00 40.00 0.02 26-46 Bentonite <br /> 46-48 Bentonite <br /> 148-50 Fill #3 <br /> Attachments Certification statement <br /> Geologic Log 1,the undersigned,codify that this report is complete and accurate to the best of my knowledge and belief. <br /> Well Construction Diagram Name Cascade Drilling,Inc. <br /> Geophysical Log(s) (Person.Firm a Corpoaton)(Typed or Primed) <br /> Soil/Water Chemical Analysis Address 3632 Omec Circle Rancho Cordova CalifomiE 95742 <br /> x Other Site Map Signed ccokj <br /> ( _ -o14 c-57 LICENSE NUMBER 717510 <br />