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0 9 <br /> 'The free Adobe Reader maybe used to view and complete this form. However,software must be purchased to complete,save,and reuse a awed form. <br /> File Original with DWR State of California DWR Use On -Do Not Fill In' <br /> Well Completion Repoli <br /> Page 1 of 1 Ratans lostndion Patrols( State Well Number/Site Number <br /> Owner's Well Number MW-5A No- e0120506 <br /> Date Work Began 07/13/2010 Date Work Ended 7/1312010 Latitude Longitude <br /> Local Permit Agency San Joarndn County Envirommnetal Health Department <br /> Permit Number SR059570 Permit Date 12/11/09 APN/rRS/Other <br /> Geologic Log Well Owner. <br /> Orientation OVertical 0Horizontal OAngle Specify. Name Shell Oil Products US <br /> Drilling Method Hollow Stem Au er Dulling Fluid Mailing Address 20945 South Wilmington Avenue <br /> Depth from Surface- Description CI Carson State CA 71 90810 <br /> .Feet to . Feet Describe material rain size color,ete <br /> ®'-„„z.-¢:- eoxiXer.Eu.op Weir LODatron <br /> ` " Address Cordes Ranch <br /> City Tracy County San Joaquin <br /> Latitude N Longitude <br /> Deo. Mn. Sec No. Min. Sec. <br /> 11j�p I Ir •�--- =E,rhe•—� Datum Decimal Lot: Decimal=Long. <br /> APN Book Page Parcel <br /> TownshiP Range- Section <br /> ratr.�sac- 'tocation Sicetch 'Activi <br /> (Sketdi muathe tlrewnMtiantl eH6rtorm ls. tlnmd. @New Well <br /> 0 Modigration/Repair <br /> O Deepen <br /> O Other <br /> T <br /> O Destro <br /> -we_-._- _-� �. „l DaFaw ommdores am matter, <br /> j _ maer"GEOLOGICLO[. <br /> -,::: Planned Uses,. <br /> Q Water Supply <br /> , � / i4°t. []Domestic []Public <br /> /X ❑Irtigation ❑Industrial <br /> O Cathodic Protection <br /> O Dewatering <br /> O Heat Exchange <br /> O Injection <br /> E) Monitoring <br /> O Remediation <br /> O Sparging <br /> ,_.^^ _ "`•y O Test Well <br /> 11I.Walem acrt.M..d—m 111..made.QFdlr9e.rates 0 Vapor Extraction <br /> eam assn a map.Uae addrmal"per r�aa�arv. OOther <br /> YleXnbaccunUaM amm lets. <br /> p::.. ater Level and Yieldof 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 representative of a well's long tens 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 Fill Description <br /> Feet to Feel Inches Inches Inches inches Feet ID Feet <br /> 6--130 8 1 Blank JPVC Soh.40 1 12 1 1 0 26 Cement Portland cement <br /> 30 45 8 ScreenPVC Sch.40 2 Milled Slots 10.020 26 28 Bentonite <br /> 28 45 Filter Pack 21125and <br /> 45 51 Bentonite <br /> :Attachments Certification.Statement . <br /> ❑Geologic Log I,the undersign certify th t t Is p sminplete and accurate to the best of my knowledge and belief - <br /> ❑Well Construction Diagram Name <br /> T�117 if Ina <br /> ersen, 1 E Gra � <br /> ❑ Geophysical Log(s) CA <br /> 11SoilfWater Chemical Analyses ly Stale f <br /> ❑ Other Signed ( VJ <br /> AaachaddalDnalin/amatlm elteXlets, CSr ailed water Well CantracIef DareS ned C-57 License Niffither <br /> DWR im REV.lacca IF ADDITIONAL SPACE IS NEEDED,USE NEM CONSECUrNELY NUMBERED FORM <br />