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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 toren. <br /> File Original with DWR Slate of California DWR Use Onl —DO Not FII In <br /> Well Completion Report <br /> Page 1 Of 1 Refer to kshuCicv Pamphlet State Well NumbedSae Number <br /> Owner's Well Number MW-4 No. e0120505 W <br /> Date Work Began 07/16/2010 Date Work Ended 7/1612010 Latltude Lon nude <br /> Local Permit Agency C....joacluin Co n G �1•� mr.ef I HPmlfh Department <br /> Permit Number SR059570 Permit Date 12/11/09 APNrtRS/Other <br /> Geologic Log Well Owner: <br /> Orientation OVertical O Horizontal OAngle Slusi Name Shell Oil Products US <br /> Drilling Method Hollow Stem Auger Drilling Fluid Mailing Address 20945 South Wilmington Avenue <br /> 'Depth from Surface Dest1ripflon - Carson CA 90810 <br /> .Feet to Feet Deauibematedal. rein at color,etc Ci State__Zi <br /> Well Location - <br /> ® _ Address Cordes Ranch <br /> City Tracy County San Joaquin <br /> . � Latitude N Longitude _yJ <br /> Dep. Min. S.C. Dep. Min. sec. <br /> Datum Decimal Lat. Decimal Long. <br /> APN Book Page Parcel <br /> TownshiD Range Section <br /> _ Location'Sketch Activity <br /> (Sketch must Ea drawn by hand iiii form is ted.) QhiBW WBII <br /> O ModiftcatioNRepair <br /> O Deepen <br /> O Other <br /> `O Destroy <br /> osscam pa aures aid maniam <br /> I__— \——, <br /> aercl[otocle tae <br /> 1 7,-� I . :Planned Uses. <br /> O Water Supply <br /> ❑Domestic ❑Public <br /> X 55 ❑Irigatlon ❑Industrial <br /> O Cathodic Protection <br /> O Dewatering <br /> �y., / O Heat Exchange <br /> 0 Injection <br /> 0 Monitoring <br /> _ O Remediation <br /> Sparging <br /> .q O Test Well <br /> nuwaN orcesvae ema�mY,eo renin mens,wialres.renins, O Vapor Extraction <br /> mem,ma.aa aw>,am.o.useamshaai Fanars2o•sur. O Other <br /> Fl.aa e.,uunr.spa r� <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 /> 'Ma not be reresemadve of a well's long term yield. <br /> Casings Annular Material <br /> Depth from Borehole Te Material Wall Outside Screen Slot Size Depth from <br /> Surface Diameter.. yp Thickness Diameter Type If Any Surface Fill Description <br /> Feet to Feet Inches Inches Inches Inches Feet to Feel <br /> 0 T30 18 Blank 1 PVC Bch.40 2 0 26 Cement I Portland cement <br /> 30 45 8 Screen PVC Bch.40 MMIlled 0.020 26 28 Bentonite <br /> 28 45 Filter Pack 12112 sand <br /> Attachments Certification Statement <br /> ❑Geologic Log 1,the undersig certify 1.1hattIsre on is complete and accurate to the best of my knowledge and belief <br /> ❑Well Construction Diagram Name or <br /> ❑Geophysical Logs) CA <br /> ❑Soil/Water Chemical Analyses C11 f 71 0 Stare <br /> ❑Other Signed 6 <br /> Abaco additlooa irformiflcni s it exists. C-57 Uoiti Waterwell Contractor Me Signed C-57 License Number <br /> DWR 186 REV.12006 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />