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'The free Adobe Reader may be used to view and complete this form. However,saftware must be purchased to complete,save,and muse a saved form. <br /> File Original with DWR State of California .DWR Use Only-Do Na Fill in <br /> Well Completion Report <br /> Page 1 of 1 Rakrlolnstruciloapamphlet State Well Numbre--N5�ae Number <br /> Owner's Well Number MW-7 No. e0120508 1__L_l I IN I I I I I1E <br /> Date Work Began 07/13/2010 Date Work Ended 7/13/2010 Latitude Longitude <br /> Local Permit Agency San joauttinr mDepartment <br /> Permit Number SR059570 Permit Date 12/11/09 APN/TRS/Other <br /> Geolo-is Lod - 101#11 OWTer <br /> Orientation OVertical O Horizontal OAngle specify Name Shell Oil Products US <br /> Drilling Method Hollow Stem Auger Drilling Fluid Mailing Address 20945 South Wilmington Avenue <br /> Depth"kam Saes s Description Carson State CAi 90810 <br /> Feet to Feet Deacriba inetaddraln-size edlor,.etc Ci <br /> r <br /> GGMGTEU LOG Well Location <br /> ®` _ Address Cordes Ranch <br /> _- '- city Tracy County San Joaquin <br /> Latitude N Longitude _w <br /> Dep. Min. SeDen. Min. Sec. <br /> Datum Decimal Lat. Decimal Long. <br /> ...._ - APN Book Page Parcel <br /> Townshi Ran a Section <br /> .Location Sketch Activi <br /> (sketch muat6aamwn cy hone anpnamt is pdmed.l @e New Well <br /> Modification/Repair <br /> O Deepen <br /> p Other <br /> Destroy <br /> oder'GE LCGICLam namnzs <br /> uMer-GEOLWIL LOG <br /> PlannedUses <br /> C)Water Supply <br /> ❑Domestic ❑Public <br /> []irrigation ❑Industrial <br /> n. <br /> ' � -• rJ Cathodic Protection <br /> - I Q Dewatering <br /> I Heat Exchange <br /> Injection <br /> , x <br /> � I <br /> Monitoring <br /> - <br /> �r, I �Remediation <br /> T <br /> �= "ger C]Sponging <br /> N I Test Well <br /> t _. ,�awllwm mme wanNs,ra ice. 0 Vapor Extraction <br /> m.a.eta.+m aima�:m:p.ure waw.nlwce�nrea�a,r. Q Other <br /> PNesbeccunM end can l4. <br /> F+•• <br /> ater Celel and Yield 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 yeld. <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 /> Feel to Feet Inches Inches Inches Inches Feel to Feet <br /> 0 33 8 Blank JPVC Sch.40 1 12 1 0 29 Cement Portland cement <br /> 33 8 Screen -- PVC Sch.40 2 Milled Slas 0.020 29 31 Beaonge <br /> 31 48 Filter Pad 2/12 sand <br /> 48 51 1 Bentonite <br /> Attachments; Certification Statement <br /> ❑Geologic Log I,the undersigned, rti a t 's re,oi t:o I to and accurate to the best of my knowledge and belief - <br /> ❑Well Construction Diagram Name <br /> rat <br /> ❑Geophysical Log(s) La7 CA <br /> ❑SoIVWater Chemical Analyses <br /> ❑Other Signed d G [ ` sla <br /> Attach adNdonal information If it adsla. 05T Licari wafer will C cMr ate Signed C-5 (Dense Number <br /> DWR IN REV.1/1006 IF ADDITIONAL SPACE IS NEEDED.USE NEM CONSECUTNELY NUMBERED FORM <br />