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0 0 <br /> 'The free Adobe Reader may be used to view and complete this form. However,software must be purchased to complete,save,and reuse a saved form. <br /> File Original with DWR State of California DWR.Use Only-Do Not Fill In <br /> Page 1 or 1 Well Completion Report <br /> aeferlolnsnudion Pamphlet State Well Number/Site Number <br /> Owner's Well Number MW-6 No. e0120507 <br /> Date Work Began 07/13/2010 Date Work Ended 7/13/2010 Latitude Longitude <br /> Local Permit Agency San joaguinCounty Fnolrnnmnetal Health Department <br /> Permit Number SR059570 Permit Date iLl1/09 APNrrRS/Other <br /> .Geolo is Lo - Well QWlter- <br /> Orientation OVertical O Horizontal OAngle Specify Name Shell Oil Products US <br /> Drilling Method Hollow Stem Auger Dolling Fluid Mailing Address 20945 South Wilmington Avenue <br /> Depth from Surface Description Cf Carson State CA 7i 90810 <br /> Feet to Feet DdwAbe material,grain size,color,etc <br /> .aa„aweuloa Well Location <br /> Address Cordes Ranch <br /> City Tracy County San Joaquin <br /> Latitude N Longftude w <br /> Deo. Min. Sec.- Dao. Min. Sec. <br /> r <br /> Datum Decimal Let,_Decimal Long. <br /> APN Book Page _ Parcel <br /> ..- <br /> Township Rande Section <br /> eamtsreer-^ <br /> Location Sketch <br /> Activit <br /> sketch mut ba dmwn bhand axer form is nmod. O' New Well <br /> O ModificatioNRepair <br /> O Deepen <br /> '--( -. OOther <br /> -"i Q Destroy <br /> I want.c�o®ar..ara msenxu <br /> a waet'GEOLLGICICG' <br /> -----— — PtanneOLlseis <br /> -owiI� O Water Supply <br /> []Domestic []Public <br /> ❑Irrigation ❑Industrial <br /> - -- x' <br /> O Cathodic Protection <br /> I O Dewatering <br /> I O Heat Exchange <br /> 0Injection <br /> 0 Monitoring <br /> '44 <br /> I O Remediation <br /> r O Sparging <br /> O Test Well <br /> I` O Vapor Extraction <br /> ` `rs`etcam anzaa.a us,euilvrw p:yarvrewszvy r O Other— <br /> Water Level'andYield <br /> ther ater:Level'andYield of.Completed Well <br /> Depth to first water 37 (Feet below surface) <br /> Depth to Static <br /> Water Level (Feet) Date Measured <br /> Total Depth of Boring 50.5 Feet Estimated Yield (GPM) Test Type <br /> Total Depth of Completed Well 45 Feet Test Length_ (Hours)Total Drawdown_(Feet) <br /> *May not be representative of a well's long term yield. <br /> Casings .Annular Material <br /> Depth from Borehole Type Material Wall outside Screen Slot Size Depth from <br /> Surface Diameter Thickness Diameter Type If Any Surface Fill Description <br /> Feet m Feet Inches Inches Inches Inches Feet to Feet <br /> 0 30 18 Blank I PVC Sen.40 1 12 1 0 26 Cement Portland cement <br /> 30 45 8 Screen PVC Sm.40 2 Mined Slots 0.020 26 28 Bentonite <br /> 28 45 Filter Pack 2/12 sand <br /> 45 51 Bentonite <br /> Attachments: :. -' Certification'StBtement <br /> El Geologic Geologic Log I,the undersign sit thai.th o i complete and accurate to the best of my knowledge and belief <br /> ❑Well Construction Diagram Name O <br /> ❑Geophysical Log(s) CA <br /> ❑Soil/Water Chemical Analyses Ix I state np <br /> ❑Other Signed I ti <br /> Attach additional Information.I it axisis. T aper we I ator le Slbned C-57 License NumTer <br /> MR 188 REV.1`2008 IF ADDITIONAL SPACE IS NEEDED.USE NEXT CONSECUTIVELY NUMBERED FORM <br />