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ORIGINAL STA'T'E OF CALIFORNIA R tjSE ONLX — 1N <br /> File with DWR WELL COMPLETION REPORT <br /> page-_of-1— Refer to Instruction Pamphlet STATE WELL NOISTATION NO <br /> Qwn—'s Well No . MVV-2RNo 807232 <br /> Date Work Began April 2.2003 Ended April 2 2003 LATITUDE LONGITUDE <br /> Local Permit Agency San Joa uin county Public Health Services <br /> Permit No 31046 Permit Date &k9ust 30,2002 APHlTRSIOTHER <br /> GEOLOGIC LOG WELL OWNER <br />' ORIENTATION (.:�) �VERTICAL -HORIZONTAL -ANGLE -(SPECIFY) Name Rose Rpdge�s <br /> DRILLING <br /> DEPTH FROM METHOD FLUID Mailing Address 11900,S limon Road <br /> SURFACE DESCRIPTION Manteca CA 95336 <br /> Ft to FI Describe material grain size color etc CITY R' T STATE ZIP 0 1 23 1 Cla a Silt,reddish-brown WELL LOCATION <br /> Address <br /> 23 1 28 1 Silty Clay olive brown City Stockton <br /> 28 1 30 1 Gla a Silt,olive brown County SRn Jonquin <br /> { ' APN Book 147 T Page 74 Parcel 7 <br /> 1 1 Township Range Section <br /> 1 ' Latitude NORTH Longitude, I i WEST <br /> 1 1 DEG MIN SEC DEG MIN SEC <br /> LOCATION SXETCH ACTIVITY (�) <br /> l 1 NORTH ✓ NEW WELL <br /> 1 1 MODIFICATION/REPAIR <br /> l 1 _ Deepen <br /> 1 ___„ 011ier(Specily) <br /> 1 1 DESTROY(Describe <br /> 1 1 Procedures and Materrals <br /> Under GEOLOGIC LOG") <br /> 1 1 PLANNED USES (zL) <br /> l 1 WATER SUPPLY <br /> - Domesllc �_ Public <br /> 1 1 _ Inirystlon �_ Induelrial <br /> 4 1 3 W MONITORING ✓ <br /> 1 1 TEST WELL <br /> 1 1 CATHODIC PROTECTION_ <br /> 1 r HEAT EXCHANGE <br /> I � <br /> DIRECT PUSH <br /> INJECTION <br /> 1 1 <br /> VAPOR EXTRACTION_ <br /> 1 l SPARGING <br /> 1 111ussmte or Describe Distance of♦Well train Roads Buildings REMEDIATION <br /> 1 1 FC11Cfa Rivers etc and attachn re�lpp Use addillanal per rf OTHER(SPECIFY) <br /> necessary PLEASE BE ACCURATE(r COMPI E7 <br /> 1 1 <br /> 1 r <br /> WATER LEVEL & YIELD OF COMPLETED WELL <br /> 1 l DEPTH TO FIRST WATER—23 (Ft)BELOW SURFACE <br /> 1 DEPTH OF STATIC <br /> WATER LEVEL 21.40 ,—(Ft)A DATE MEASURED Aonl 10.2003_ <br /> i 1 <br /> ' TOTAL DEPTH OF BORING 30 (Feel) ESTIMATED YIELD (GPM)R TEST TYPE <br /> TEST LENGTH (Hrs)TOTAL DRAWDOWN(N) <br /> TOTAL DEPTH OF COMPLETED WELL 30 (Feet) •May not be representative o a well's ton -terns yield <br /> DEPTH BORE CASING (S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE HOLETYPE(t) FROM SURFACE TYPE <br /> (DDIA MATERIAL INTERNAL GAUGE SLOT SIZE CE BEN- <br /> Fl to FI GRADE DIAMETER OR WALL IF ANY MENT TONrTE FILL FILTER PACK <br /> (Inches) THICKNESS (lnohea) FL to Ft {�) (�) (�) (TYPE/SIZE) <br /> 0 1 15 8 ✓ PVC 2 Sch 40 0 1 11 ✓ <br /> 15 1 30 8 ✓ PVC 2 Sch 40 0 020 11 1 13 ✓ <br /> 30 ✓ #3 Sand <br /> l I <br /> 1 1 <br /> 1 ATTACHMENTS CERTIFICATION STATEMENT <br /> — Geologic tog I the undersigned certify that this report Is complete and accurate to the best of my knowledge and belief <br /> — watt Construction Diagram NAME Cascade Onlling,Inc <br /> r <br /> �- Geophysical Log(s) (PERSON FIRM OR CORPORATIONI (TYPED OR PRINTED) <br /> — SoWWatar Chemical Anayses 3632 Omec Circle Rancho Cordova CA 95742 <br /> — Other ADDRESS Cl7Y STATE 211, <br /> ATTACH Ao01TIONAL INFORMA77ON IF IT EXISTS _ June 18,2003 717510 <br /> Sl <br /> WELL ERIAUTNDRIZED EM IYE DATE SIGNED C 57 LICENSE NUMBER <br /> DaR TSB REV II jr, IF ADDITIONAL SPACE IS NEEDED USE NEXT CONSECUTIVELY NUMBERED FORM <br /> 1 <br />