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0 0 <br /> 'The free Adobe Reader may be used to view and complete this form. However,software most 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 Refer to lnsfrucfmn Pampnef State Well Numbre--HSite Number T <br /> Owners Well Number MW-9 No. e0120510 <br /> Date Work Began 07/14/2010 Date Work Ended 7/14/2010 Latitude Longitude <br /> Local Permit Agency San joactuln Co I Department <br /> Permit Number SR059570 Permit Date 12/11/09 APNrrRS/Olher <br /> Geologic Log Well Owner: - <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 from Surface - -Description Ci Carson Stale CA �i 90810 <br /> Feel to Feet Desaibe material rain size,color,etc <br /> morass .�aanrm.,pp -.: Well 1-6e8ti6h <br /> Address Cordes Ranch <br /> City Tracy County San Joaquin <br /> Latitude N Longitude __w <br /> pea. Min. Sae. Dep, Mm. Sec. - <br /> 11-� Datum Decimal Let. Decimal Long. <br /> APN Book Page Parcel <br /> Township Panne Section <br /> Location Sketch Activity <br /> _ __Iskclrhmvsean� na ndwh :m�Lr,M�=nc New Well <br /> O Modification/Repair <br /> O Deepen <br /> O Other <br /> - —"i O Destroy <br /> Qe,PzA pmmCu,esaMmbentl9 <br /> I__—_—_—.—__.—_—_ - I_._ warceoLacic Loc <br /> — I •Planned Uses <br /> O Water Supply <br /> ❑Domestic []Public <br /> ❑Inigation ❑Industrial <br /> __ ar O Cathodic Protection <br /> O Dewatering <br /> r O Heat Exchange <br /> � ,�s.' 0Injection <br /> �._ zl// O Monitoring <br /> O Remedlation <br /> O sparging <br /> O Test Well <br /> wmax orneemoemsu�aaenrvpm ml mranecc roams. OOther Extinction <br /> -- ,na,c ai=.am allaNa maP use amxla,al pyerrmmwy. O Other <br /> Plaaaa b+amraN antl can Ma. <br /> atsr-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 /> 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 re resentative 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 if Any Surface FIII Description <br /> Feel to Feet Inches Inches Inches Inches Feet to Feet <br /> 0 30 8 1 Blank JPVC Sch.ao 1 12 10 26 1 Cement Port and cement <br /> 30 45 8 screan PVC Sch.4o 1 J2 Milled Slots 10.020 26 28 Bentonite <br /> 28 45 Fllter Pack 2112 sand <br /> 45 51 Bentonite <br /> Attachments - Certification Statement <br /> ❑ Geologic Log I,the undersigned, that is 180-0co p to and accurate to the best of my knowledge and belief - <br /> ❑Well Construction Diagram Name <br /> F rscoryo <br /> 11 Geophysical Log(s) CA <br /> ❑ Soil/Water Chemical Analyses - c `� Stam v <br /> 11 Other Signed <br /> Attach additional Inlonnali If it MIS Gal Ucen ater Well CaMractor ate$i ned C-57 License Number <br /> DWR 1Sa REV.12006 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />