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'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 Net In <br /> Well Completion Report <br /> Page 1 of 1 Refer to lasrwbn Pampinat <br /> State Well Number/Bile Number <br /> Owner's Well Number MW-2 No. ¢0120503 I I I I I I I � - <br /> Date Work Began 3l12/2010 Date Work Ended�Efi2/2010 Latitude Lon Rude <br /> Local Permit Agency San Joaquin County Enviromm�etal Health Department <br /> Permit Number SR059570 Permit Date 12/11/09 APNrrRS/other <br /> Geolo. is Lo Well C linnet'" <br /> Orientation OVertiral 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 C• Carson gars CA �; 90810 <br /> Fast to Feet Describe material, rain size color,etc' <br /> Wel�Go6a on <br /> ® _ .eeawwa..ee Address Cordes Ranch <br /> Ciry, Tracy County San Joaquin <br /> Latitude N:Longitude _may <br /> -— Use, Mn. Sec Deo. Min. Sec. <br /> Datum Decimal Lat. Decimal Long. <br /> APN Book "Page Parcel <br /> Township -Range Section <br /> Location Sketch `Activity <br /> ketrhmusbedrawn handafterlmmis rimed. 0e New Well <br /> • 1 - -"-_.,.�,_.M-.. O ModificatioNRepair <br /> x — O Deepen <br /> ` O Other <br /> `O Destroy <br /> oerleao�eum..m mmnak <br /> L _-_-_. mwercaaocrcLoc <br /> :Plashed USESc <br /> O Water Supply <br /> �, [:]Domestic []Public— _ -=r••- _ 44 ❑Irrigation []industrial_ / w• O Cathodic Protection <br /> u <br /> =ar:-r r- xpE O Dewatering <br /> O Heat Exchange <br /> • r— / ' I O Injection <br /> X;// I 9 Monitoring <br /> I O Remediation <br /> II O Sparging <br /> § O Test Well <br /> O Vapor Extraction <br /> mem ar cecmce ea+eaoe a�.an vom may.wai�ae,rerma. <br /> rwr <br /> i em.am.lurn.mw.ua animas o�mx2e:rwy.aO Other <br /> Water 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 45.5 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 yield. <br /> Casings Annular'Material <br /> Depth from Borehole Wall Outside Screen Slot Size Depth from <br /> Surface Diameter Type Material Thickness Diameter Type It Any Surface Fill Description <br /> Feet to Feet Inches Inches Inches Inches Fast to Feet <br /> 0 130 18 1 Blank JPVC Sch.ao 1 12 0 26 cement Portland cement <br /> 30 45 8 Schwan PVC Sch.40 2 Mined Slots 10.020 26 28 1 Bentonite <br /> 28 45 Fluter Pack 2/12 sand <br /> Attachments Certification Statement <br /> ❑Geologic Log I,the undersi d,certify th s to i4 Complete and accurate to the best of my knowledge and belief <br /> ❑Well Construction Diagram Name <br /> ❑Geophysical Log(s) A <br /> ❑OtherSo]VWater Chemical Analyses A smgA�, �Lp <br /> ❑Other Signed !9 f$�j��]' ('p <br /> A"IIZ additional information flitmds% c-eT LC <br /> sed Water We Cmeador Dle Signed C•5 Llcenee Number <br /> MR 188 REV.lame IF ADDITIONAL SPACE IS NEEDED,tf5E NEXT CONSECUTIVELY NUMBERED FORM <br />