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10 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 of 1 Well Completion Report <br /> Re/er to/n9n#Acn Pamphlet State Well Number/Site Number <br /> Owner's Well Number MW-5B No. e0120515 L N <br /> Date Work Began 09/01/2010 Date Work Ended 9/1/2010 Latitude Lan kude <br /> Local Permit Agency San Joaguin County Envirommnetal Health Deoartment <br /> Permit Number SR060766 Permit Date 7/6/10 APN/TRS/Other <br /> Geologic Log Well Owner <br /> Orientation O Vertical O Horizontal OAngle specify Name Shell Oil Products US <br /> Drilling Method Sonic Drilling Fluid Mailing Address 20945 South Wilmington Avenue <br /> Depth from Surface Description - Carson CA 90810 - <br /> Feet b Feet Describe material rain size color,etc C' State <br /> � � eoeweweuroo .. Well Location <br /> Address Cordes Ranch <br /> City Tracy County San Joaquin <br /> latitude N Longitude___w <br /> �! Dee. Min. Sec. Dee. Mn. Se, - <br /> ; <br /> Daturki Decimal Lat Decimal Long. <br /> APN Book Page _ Parcel <br /> _ Townshi Range. Section <br /> Location Sketch ActiVi <br /> ty <br /> Sketch muslbdrem haMMerfoim la. m4. (j)Now Well <br /> -- — — Q Modification/Repair <br /> O Deepen <br /> - —`' j O Other <br /> O Destroy <br /> un+e.n�s.su.ea mels uu <br /> - w..'cEOLacIC LOG' <br /> - ------ — -- -- .Planned DSee' . <br /> y O Water Supply <br /> ❑Domestic []Public <br /> I ❑imigallon ❑Industrial <br /> �. <br /> O Cathodic Protection <br /> O Dewatering <br /> O Heat Exchange <br /> f, O Injection <br /> o' Monitoring <br /> O Remediation <br /> O Sparging <br /> O Test Well <br /> waewoeemo.mmma.Mewn maee,Maa�r,.�os, O Vapor Extraction <br /> r�nen.sic and aMaamo wmlewosr,r�..r. O Other <br /> Ater Leve'and Yleld 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 45.5 Feet Estimated Yield (GPM) Test Type <br /> Total Depth of Completed Well 45 Feet Test Length (Hours)Total Drawdown (Feet) <br /> 'Ma not be re resentative of a well's long term yield. <br /> Casings -' Annitlal Mlaterial <br /> Depth from Borehole T Material Thickness <br /> Outside Screen Slot She Depth from <br /> Surface Diameter Type Thickness Diameter Type if Any Surface Fill Description <br /> Fact to Feet Inches Inches Inches Inches Feet W Feet <br /> 0 1105 6 1 Blank JPVC Sch.4o 1 12 1 1 0 97 Cement Portland cement <br /> 105 115 6 Screen PVC Sch.40 12 1 Milled Slots 10.020 97 102 Sentonfle <br /> 102 115 Filter Pack 2/12 sand <br /> Attachments 'Certification Statement <br /> ❑ Geologic Log I,the undersigpgd,}xrtify Vt this reort is w_rpplete and accurate to the best of my knowledge and belief - <br /> ❑Well Construction Diagram Name (.Parson Firm y D Q r e�t, yO a <br /> t. <br /> ❑Geophysical Log(s) 0 0 K ir.5f--- UIcn LSCA 9-<6 5Y <br /> ❑ Soil/Water Chemical Analyses Add <br /> Signed DIry -�7--Lv Stale <br /> 11 3 �� <br /> ❑Other <br /> Aeam aed'mwW lmotmatio,eaaris6. Osr ucemed water well Coni-M91,15rDate Signed C-57 License Number <br /> DWR 188 REV,16NX16 IFADDI ONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />