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'The free Adobe Reader may be used to view and complete this farm. 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 /> Well Completion Report <br /> Page 1 of 1 Rera 0Ms"fon PampMer <br /> Siete Well Number/Slim Number <br /> Owner's Well Number MW-8 No. e0120509 <br /> Date Work Began 07/15/2010 Date Work Ended 7/15/2010 Latitude Lon dude <br /> Local Permit Agency San JoaOuin County Envirommnetal Health Department <br /> Permit Number SR059570 Permit Date 12/11/09 APNfTRS/0ther <br /> Geologic Log Well Owner <br /> Orientation O Vertical O Horizontal OAngls Specify Name Shell Oil Products US <br /> Drilling Method Hollow Stem Auger Drilling Fluid Mailing Address 20945 South Wilmington Avenue <br /> Depth,from Surface Description CI Carson State Chi 90810 <br /> Fact to Feet Describe matedal,grain size,colo[etc <br /> -. Well Location <br /> ®_ _ sowm.Lrao Address Cordes Ranch <br /> — -' <br /> City Tracy County San Joaquin <br /> .-..—�•� Latitude ___ N Longitude - w <br /> near Mn. Sc Dea. Min. Sec. - <br /> i <br /> Datunrl Decimal Lat. Decimal Long. <br /> APN Book Page Parcel <br /> T <br /> Township —Range Section <br /> Location Sketch Activity <br /> .tstweh,mpydted bandaurranieoljmeat 11 @New Well <br /> ;,;, ;�_�. '• Q Modification/Repair <br /> O Deepen <br /> O Other <br /> Q Destroy <br /> j _ j ueFtGE GICUW mb. <br /> * i uNe,'GEOLCGIL LOG' <br /> Planned Uaes` <br /> O Water Supply <br /> % �. ❑Domestic [:]Public-- X. ❑Irtigation ❑Industrial <br /> O Cathodic Protection <br /> e"'"51"='""—"" O Dewatering <br /> O Heal Exchange <br /> O Injection <br /> 0e Monitoring <br /> O Remediation <br /> ..h.. O Sparging <br /> s, O Test Well <br /> in�mae oreesolee alzuem m.eurmm mms,o-,eei�oe.ewe. O Vapor Extraction <br /> -- alo.em m,aemw uw aearn�a lvperrrewsaY. OOther <br /> itter Level 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 /> [Tolal, h of Boring50.5 Feet Estimated Yield' (GPM) Test Type <br /> h o[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 Wall Outside Screen Slot Size Depth from <br /> Surface Diameter Type Material Thickness Diameter Type I/Any Surface Fill Description <br /> Feel to Feet Inches Inches Inches Inches Feet to Feet <br /> 0 130 18 1 Blank JPVC Sen.40 1 12 1 1 0 26 cement Portland cement <br /> 30 45 8 Screen PVC Sen.40 2 Milled Slots 10.020 26 28 Bentonite <br /> 28 45 Filter Pack 2/12 sand <br /> 45 51 Bentonite <br /> -. Attachments Certification Statement <br /> ❑ Geologic Log I,the undersigns cerci th chi repod is m t and accurate to the best of my knowledge and belief <br /> ❑Well Construction Diagram Name e k- If rvl <br /> 11Geophysical Log(s) or t LA <br /> ❑SoiVWater Chemical Analyses <br /> 11 Other Signed � <br /> tSl Anadt C57 Uc water wen Contractor nStacey/ /l/�n1p <br /> � <br /> C-57 License Number <br /> DWR tee REV.laces IF ADDITIONAL SPACE 15 NEEDED.USE NExT CONSECUTIVELY NUMBERED FORM <br />