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1 <br /> ORIGINAL STATE OF CALIFORNIA QWR USE N — DQ NOT FILL IN <br /> File With bWR WELL COMPLETION REPORT <br /> Page—J—Of I Refer to Instruction Pamphlet STATE WELL NOISTATION NO <br /> Owner's Well No -IW-3R NO 807233 <br /> Date Work Began-April 2.20 LATITUDE LONGITUDE <br /> g0�..__ , Ended April 2,2003 <br />' Local Permit Agency San Joarguin County Public Health Services _ _ __ <br /> Penna No 33256 Permit Date March 27,_2003 APN/TRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br />' ORIENTATION VERTICAL -HORIZONTAL __ANGLE -(SPECIFY) Name—F3odGe{s Estate <br /> m. <br /> DRILLING -e. <br /> DEPTH FROM <br /> METHOD FLUID Mailing Address 11900 Union Road <br /> SURFACE DESCRIPTION Manteca CA 95336 <br /> FL to FL Describe material grain S7=e COlnr, etc CIN STATE ZIP <br /> 0 3 + Fill,silty cls WELL LOCATION <br /> Address W.Charter Wgy <br /> 3 + 30 t Clayey Silt,brawn to dark greyCity StocktpR <br /> I + County San Joaquin - -- - � <br /> ' APN Book Page Parcel <br /> 'Township Range Section <br /> Latitude—__L_ I TH Longitude + r WEST <br /> 1 , DEG MIN SEC DEG MIN SEC <br /> LOCATION SKETCH ACTIVITY (4) <br />' ' 1 NORTH NEW WELL <br /> ' MODIFICATION/FIEPAIR <br /> I e - Deepen <br /> + — Other(Specity) <br /> DESTROY(DeacrEAe <br /> PrOC1 <br /> Under EOLOQICdur"and Ir <br /> LOG) <br /> ' PLANNED USES (.!L) <br /> I WATER SUPPLY <br />' _ Domestic _ PalyI1C <br /> r e <br /> in _ Irrigation industrial <br /> 1 ' MONITORING✓ <br /> TEST WELL_ <br /> 1 I CAlHON <br /> PROTECTIO <br /> HE <br /> 1 I HEAT EXCHANGE_ <br /> DIRECT PUSH <br /> INJECTION <br /> VAPOR EXTRACTION <br />' ' I SPARGING <br /> SOUTH REMEDIATION <br /> lllostrate or Describe Distance of Wellbore Roads Raiddorgs <br /> I Feircrs Rrurs etc and attach a pliap Use addworr l per 1i OTHER(SPECIFY) <br /> necmarr� PLEASE BE ACCURATE&COUPLE,Jyrt <br /> WATER LEVEL & YIELD OF COMPLETED WELL <br /> r <br /> , I DEPTH TO FIRST WATER 23 (Fr)BELOW SURFACE <br /> DEPTH OF STATIC <br /> ' 1 WATER LEVEL_. 21.31 (Ft)&DATE MEASURED___. April 10.2003„ <br /> TOTAL DEPTH OF BORING 30 ESTIMATED YIELD` (GPM)a TEST TYPE= <br /> (Feet) TEST LENGTH (Hra)TOTAL DRAWDOWN,,,,._,(Ft) <br /> TOTAL DEPTH OF COMPLETED WELL J0- (Feet) May not be representative of a well'E long-term yield <br /> DEPTH BORE CASING (S) DEPS ANNULAR MATERIAL <br /> FROM SURi ACE HOLE TYPE(�) FROM SURFACE TYPE <br /> DIA w MATERIAL I INTERNAL GAUGE SLOT SIZE CE SEN <br /> Ft to Fl Rr+a+e`) & GRADE DIAMETER OR WALL IF ANY MENT ITONITE FILL FILTER PACK <br /> ��1»i W I (PnChea) THICKNESS triches) Ft to Ft (TYPE/SIZEl <br /> 0 1 15 6 ✓ PVC 2 Sch 40 0 i 11 ✓ <br /> 15 I 30 8 ✓ PVC 2 Sch 40 0 020 11 1 13 ✓ <br /> ----------------- <br /> ' 13 30 ✓ #3 Sand <br /> 1 <br /> 1 1 <br /> ATTACHMENTS (y) CERTIFICATION STATEMENT <br /> Geologic Log 1 the undersigned certify that this report Is complete and accurate to the best of my knowledge and belief <br /> Well Construction Diagram NAME Cascade Drilling Inc <br /> -� Geophys"Logs) (PERSON FIRK DR CDRPDRATION) (TYPED OR PRINTED) <br /> SoRlWater Chemical Analyses 3632 Omec Circle Rancho Cordova CA 95742 <br /> Other ADDRESS CITY STATE ZIP <br /> A ADDITN]NAL INFORMATION 1F tT(EXISTS Shined _June 18,2003 T17510 <br /> WELL LERIAUTHORIZEDES ATIVE DATE SIGNED C 51 LICENSE NUMBER <br /> DNtR 198 REV 1i 87 IF ADDITIONAL SPACE IS NEEDED USE NEXT CONSECUTIVELY NUMBERED FORM <br />