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QUADRUPLICATE STATE OF CALIFORNIA own USE ONLY — DO NOT FILL IN <br /> For Local Requirements WELL COMPLETION REPORT <br /> Page 1 of 1 Reffi, m m,mav,n 11oniphkt STATE WELLNOJ STATION NO. <br /> Owner's Well No. E.ADA AVE No.0956999 1 ❑ ❑ <br /> Date Work Began 7/162009 , Ended7/2l/2009 LATITUDE LONGITUDE <br /> Local Permit Agency SAN.IOAOLIIN CO FHD <br /> Permit No. SR0057766 Permit Date 7/92009 APNRRSMTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(v) VERTICAL HORIzoNTAL ANGLE —(SPECIFY) Name HOME SALES <br /> DRILLING ROTARY <br /> DEPTH FROM METHOD FLUID MUD Mailing Address 10790 RANCHO BERNUDO D <br /> DESCRIPTION SAN DIEGO CA 92127 <br /> Ft. m FL Describe material, grain, si Color, e1C. CITY STATE ZIP <br /> 0 67!CLAY Address 11479 E.ADA ALL LOCATIO <br /> 67 73',SAND-FINE Cin,STOCKTON CA 95215 <br /> 73 87!CLAY County SAN JOAQUIN <br /> 87 91 '',SAND APN Book 103_Page 270 Parcel 06 <br /> 91 127''.CLAY Township Range Section <br /> 127 129:SAND Latitude <br /> 129 220 I CLAY DEG. MIN. SEC. DEG. MIN. SEC. <br /> 220 222 SAND LOCATION SKETCH ACTIVITY (�) <br /> 222 250 CLAY NORTH -10� NEW WELL <br /> TIONIREPAIRCA <br /> 250 261 SAND-COARSE MODIFIDwPe <br /> 261 267 CLAY Omar(Spa*) <br /> 267_ 271 SAND-COARSE <br /> 271 ', 280 CLAY PESTROY meedurea(m Mm'als <br /> Under'GEOLOGIC LOG' <br /> PLANNED USES([) <br /> WATER SUPPLY <br /> ra N Odnesfic Pudic <br /> 1p a� lnigalbn Industri& <br /> 5 MONITORING <br /> TEST WELL <br /> ATHODIC PROTECTION— <br /> HEAT EXCHANGE <br /> DIRECT PUSH <br /> INJECTION <br /> VAPOR EXTRACTION <br /> SPARGING <br /> SOUTH REMEDIATION <br /> nhm or D„orme Dl,m .f 114,11f.Ravd., aal/emg,, <br /> Fence,Rivers,d<. v mach a map. Use addioonel pepv S OTHER(SPECIFY) <br /> stte,s�ry. PLEASE RE ACCURATE & COMPLETE. <br /> WATER LEVEL&YIELD OF COMPLETED WELL <br /> DEPTH TO FIRST WATER . (FL)BELOW SURFACE 1 <br /> DEPTH OF STATIC <br /> V WATER LEVEL 120 (FL)&DATEMEASURED 721/29 <br /> ESTIMATED YIELD ' (GPM)& TEST TYPE _ <br /> TOTAL DEPTH OF BORING 260 (Feet) <br /> TEST LENGTH_ (t4s.) TOTAL DRAWDOWN (FL) <br /> TOTAL DEPTH OF COMPLETED WELL275 (Feet) May not be representative o a well's long-term yield. <br /> DEPTH BORE- CASING(S) DEPTH <br /> FROM ANNULAR MATERIAL <br /> FROM SURFACE ROLE YP <br /> TE �) M SURFACE PIE <br /> ( ) C-1.0 <br /> MATERIAL I INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> OIAMETER OR WALL IF ANY FILTER PACK <br /> Ft b FL O LL GRADE (Irdm) THICKNESS (Ind") Ft N FL MENi TONIT FILL <br /> (✓) �) (TYPFlSI2E) <br /> O 255 97/8 0 too <br /> 255: 275 97/8 100 275 --- OX160RAVE <br /> ATTACHMENTS CERTIFICATION STATEMENT <br /> Gealogk IN I,the uruler"ml,eartiFj that Nu report k canplel0 9MI aca to the heal d my ImaMedae and heW <br /> WN ConslmrAon Diagram NAME_CALWATER DRILLING CO_INC. <br /> Geophysical Lags) (PERSON,FIRM,OR CORPORATION) (TYPED OR PRINTED) <br /> SaMater C�l Analysis 300 S.Kilroy Rd Turlock CA 95 <br /> ADDRESS <br /> O&rer CITU STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION IF ITEMS SVI d 07/21/09 434218 <br /> WELL DRILLER/AUTH RIZED REPRESENTATIVE DATE SIGNED GET LICENSE NUMBER <br /> DWR 188 REV.11-W IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />