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Y 'AQUADRUpLICATE I STA'IirC OF CAI IFUHNt.I DWR USE ONLY — DO NOT FILL IN <br /> For Local Requirements WELL COMPLETION REPORT - <br /> page—I of-1 1 Rcfer fu lrtstntchon Famphlat STATE WELL NOISTATION NO <br /> Owner's Well No _ HN-4 No III 11IF-11111 � 111:1 <br /> 0 Q <br /> Date Woik Began '9/25/198 , Ended 9/25/98 V LATITUDE LONGITUDE <br /> Local PirrrnitAgency San JoaQuin Ce, N Env. If alfh D", <br /> Petnnt ilio 015568 ,.,_Pernnit Date 9 � APNITRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION (✓ -x–VERTICAL _HORIZONTAL _ANGLE _(SPECIFY) Marne Chevron' Products Company <br /> DRILLING Mallin AddressP.O. Box 6004 <br /> DEPTH FROM METHOD FLUID g <br /> SURFACE DESCRIPTION San jRamon ,. CA 94SR3 <br /> Ft to Ft DLsc ribs tnatc)ial brain sty( LUlOr bt(. CITY STATE ZIP <br /> 0 I 60.5 Pressure grouted with neat Acldie,,s '12XX*\VELE 134LOAT[OS.N S1 Dorilidc'r <br /> I cement. Top 5 feet ofcasing­ city Stockton_.....-_,_�� _ <br /> : drilled out. coiintv San Joasluin <br /> APN Boots Pnge Parcel <br /> Township Range Section <br /> I I L ititiide I I NORTH I OTigitndc I i WEST <br /> DEG MM SEC DEG MIN SEC <br /> LOCATION SKETCII ACTIVITI (iL) <br /> NORTH <br /> NEW WELL <br /> MODIFICATIONIREPAIR <br /> i See map. _ Deepen <br /> i I — Other(Specify) <br /> DESTROY(Describe <br /> I I Procedures and Materials <br /> Under GEOLOGIC LOG) <br /> ' PLANNED USES (2L) <br /> I I WATER SUPPLY <br /> Demestic Public <br /> � F- Irngaiion Industrial <br /> I I Lu w MONITORING <br /> TEST WELL— <br /> I i CATHODIC PROTECTION T <br /> HEAT EXCHANGE <br /> I I DIRECT PUSH <br /> I I <br /> INJECTION <br /> VAPOR EXTRACTION—...� <br /> i r SPARGING <br /> i SOUTH REMEDIATION <br /> 11histratc or Ucscnbc Uisiancc of Wi fl frvin Roads Btdduigs <br /> I ancc s RmcrS etc and attach a ma Use additional J apei f OTHER(SPECIFY)_ <br /> nrrrssaiz! PIFASFBF ACCUBATk &CObMPIFTF <br /> WATER LEVEL & IIELD OF COMPLETED WLLL <br /> I I <br /> DEPTH TO FIRST WATER (Ft) BELOW SURFACE: <br /> DEPTH OF STATIC <br /> WATER LEVEL (Ft)&DATE MEASURED <br /> I <br /> ESTIMATED YIELD (GPM) & TEST TYPE <br /> TOTAL DEPTH OH BORING {left) TEST LENGTH (Firs) TOTAL DRAWDOWN (Ft) <br /> I OTAL DEP'l II OF cokipf 1�rLD 11'1 1 I. (Feet) *May riot be I cprerentattvc of a well's long-telsn yield <br /> DEPTH CASING (S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE BORE HOLE TYPE() FROM SURFACE TYPE <br /> INTERNAL GAUGE SLOT SIZE <br /> QIA x w o � MATERIAL/ CE BEN <br /> tlnches) z w moi– GRADE DIAMETER OR WALL IF ANY MENT TONITE FILL FILTER PACK <br /> Ft to Ft m �_ (inches) THICKNESS (Inches) Ft to Ft (TYPEISIZE) I <br /> I <br /> I I <br /> I i <br /> I I <br /> I i <br /> ATTACIIMENTS (:) CERTIFICATION STATENJI <br /> Geologic Log I the undersigned, certify that this report is complete and accurate to the best of my knowledge and belief <br /> — Well Construction Diagram NAME Pacific Et1virDCtS1@APal1 ©roup <br /> Geophysical Log(s) 113 I'S"'SUdt I ,TIO 07l D tNT&D) Ste. H, Rancho Cordovai <br /> CA <br /> SolllWater Chemical Analyses <br /> Other _i/ ADDRESS , ` r r , CITY r,S/TA"IE i ZIP <br /> j! �� f <br /> ATTACH ADDITIONAL INFORMATION IF IT EXISTS Signed 1 �' <br /> WELL DRILLERlAU •CRI2ED REPRESENTATIVE Y DATE SIGNED C/57 LICENSE NUMBER <br /> intra Inti [TFT 11 97 IF ADDITIONAL SPACE IS NEEDED USE NEXT CONSECUTIVELY NUMBERED,FORM / <br />