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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 FII In <br /> Well Completion Report <br /> Page 1 of 1 ReferlolnsboHioo Pamphlet State Well Number/SRe Number <br /> Owner's Well Number MW-10 No. e0120512 <br /> Date Work Began 07/14/2010 Date Work Ended 7/14/2010 Latitude Longitude <br /> Local Permit Agency San.Ina^uln c_r_,unty Envirommnetal Health Department <br /> Permit Number SR059570 Permit Date 12/11/09 APNrFRS/Other <br /> Geologic Log Well Owner <br /> Orientation OVertical O Horizontal OAngle Specify. Name Shell Oil Products US <br /> Drilling Method Hollow Slem Au er Onlling Fluid Mailing Address 20945 South Wilmington Avenue <br /> Depth from Surface Description Carson CA 90810 <br /> Feet to Feet Deecdbe.material, rain size color,etc Ci State I <br /> mors eoeiaa+vruLoo - Well Location.=W a— _ <br /> Address Cordes Ranch <br /> City Tracy County San Joaquin <br /> Latitude N Longitude <br /> Deal. Min. Set Dec.. Mln, S. <br /> Datum Decimal Let. Decimal Long. <br /> APN Book Page Parcel <br /> Townshi _ --Range,--- Section <br /> c4:,rerr��— Location:Sketck" Activity <br /> �$ketchmastea dmvnb and eiierfam isxdnled. () New Well <br /> -- -- -- — ——"—"——�"— O Modification/Repair <br /> O Deepen <br /> O Other <br /> 0 Destroy <br /> —�•l oexnm poaowesana mamrah <br /> _ uMm GEOLOGIC LOG <br /> ---------" Planned Uses <br /> _ 0 Water Supply <br /> []Domestic ❑Public <br /> __ %sI �• a'ay� ❑Irrigation ❑Industrial <br /> .,,tet✓,,,,, O Cathodic Protection <br /> 0 Dewatering <br /> / I O Heat Exchange <br /> msrmrrn. 77, <br /> .. Q Injection <br /> - Rios - X��"'y O' Monitoring <br /> O Remediation <br /> ' k O Sparging <br /> O Test Well <br /> O Vapor Extraction <br /> __..—cz_aia anaa,amaP.um aaStlunal PaR,ra[2OMr. ' 0Other— <br /> PW- <br /> Water <br /> therPWaate Level and Yield of Com Idled WeII <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 /> 'Ma 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 /> Suncce Diameter yp Thickness Diameter Type it Any Surface Fill Description <br /> Feet to Feet Inches Inches Inches Inches Feel to Feet <br /> 0 130 18 1 Blank PVC Sch.4o 1 12 1 1 0 26 Cement Portland cement <br /> 30 45 8 Screen PVC Sch.40 1 12 1 Milled Slots 10.020 26 28 Bentonite <br /> 28 45 Fllterfeack 2/12 sand <br /> 45 51 Bentonite <br /> Attachments Certification:Statement <br /> ❑Geologic Log I,the undersigne e ' at is r po Is co ele and accurate to the best of my knowledge and belief <br /> ❑Well Construction Diagram Name <br /> ❑Geophysical Log(s) `' --7 arc t CA <br /> ❑ <br /> Sall/Water Chemical Analyses 09 M I sw. ZIM <br /> ❑Other Signed ll <br /> Attamatldtlonal mbnnaron Hit exists. lLic Water WaX Contractor to Sl ned C-57 ansa Num er <br /> MR 108 REV.V2008 IF ADDITIONAL SPACE IS NEEOM,USE NEXT CONSECUTNELY NUMBERED FORM <br />