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3 <br /> ORIGINAL STATE OF CALIFORNIA owR USE ON Y — Do NOT FILL IN <br /> File with DWR WELL COMPLETION REPORT <br /> Paged-ofd, Refer to Instruction Pamphlet SLATE WELL NO/STATION NO <br /> Owner's Well No No 779199 <br /> to Work Began FEBRUARY 13,2002 , Ended FEBRUARY 13,02 LATITUDE LONGITUDE <br /> Cal Permit Agency San Joa uln County Public Health Services-Environmental Health Div <br /> Permit No 28821 Permit Date FEBRUARY 8,2002 APN/TRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION (z) ✓ VERTMAL _HORIZONTAL _ANGLE —ISPECIFY) Name UNOCAL CORPORATION <br /> DRILLINGHollow Steam Auger FLUID NONE Mailing Address 8788 ELK GROVE BOULEVARD BUILDING 3 STE 15 <br /> DEPTH FROM METHOD <br /> SURFACE DESCRIPTION ELK GROVE CA 9 5 6 2 4 <br /> FI to Ft Describe motertal grain sizze, color etc CITY $TATE ZIP <br /> WELL LOCATION <br /> 0 40 1 THIS WELL WAS INSTALLED WITHIN FIVE FEET Address 437 EAST MINER AVE, (SIDEV6LK 308 N-CALIFORNIA 51-1 <br /> I , OF WELL SP-5A,AND WAS NOT LOGGED City <br /> I OR SAMPLED County SAN JOAQUIN <br /> APN Book Page Parcel <br /> 1 I <br /> Township Range Section <br /> LatitudeDEG ' MIN 1 SEOORTH Ungitude DEGI MIN 1 SEC WEST <br /> LOCATION SKETCH ACTIVITY 0') <br /> NORTH ✓ NEW WELL. <br /> CNN L <br /> MODIFICATIONIREPAIR <br /> Deepen <br /> Other{Specdy3 <br /> DESTROY(Describe <br /> Procedures and Matenalsunder GEOLOGIC LOG)PLANNED USES 0 )WATER SUPPLY <br /> Domestic Public <br /> Initiation — Induslnal <br /> L MONITORING— <br /> TEST WELL-__ <br /> CATHODIC PROTECTION <br /> HEAT EXCHANGE— <br /> ` 1 DIRECT PUSH <br /> I , E , NE F" VE. INJECTION— <br /> VAPOR EXTRACTION <br /> , I <br /> SPARGING <br /> SOUTH REMEDIATION <br /> 1 I Illustrate or Describe Dntonce of Well, I <br /> from Roads Buildings} <br /> Pence& Rmers etc and attach a map Use addrtinnrtl y�nprr OTHER(SPECIFY) <br /> 1 ' necessanj PLEASE BE ACCURATE&COMPLETE <br /> ` 1 WATER LEVEL & YIELD OF COMPLETED WELL <br /> DEPTH TO FIRST WATER (Ft) BELOW SURFACE <br /> 1 , <br /> DEPTH OF STATIC <br /> WATER LEVEL (Ft)a DATE MEASURED <br /> ESTIMATED YIELD ' (GPM)A TEST TYPE --- - <br /> TOTAL DEPTH OF BORING 40 (Feet) TEST LENGTH {His)TOTAL DRAWDOWN(Ft) <br /> TOTAL DEPTH OF COMPLETED WELL 40 (Feet) 'May not be rrprestntartvt of a well's ltrn -imn yield <br /> CASING (S) DEPTH ANNULAR MATERIAL <br /> DEPTH BORE- FROM SURFACE TYPE <br /> FROM SURFACE HOLE TYPE i—') <br /> DIA Y z MATERIAL I INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> FILTER PACK <br /> d <br /> [Inra} Z w a GRADE DIAMETER OR WALL IF ANY MENT TONITE FILL <br /> Ft to Ft cd <br /> ¢i finches) THICKNESS {Indra) Ft to Ft f 0 (TYPE/SIZE) <br /> cn <br /> 0 , 37 5 8 ✓ PVC 075 0 I 30 ✓ <br /> 375 , 40 8 ✓ MICRO 30 1 35 ✓ <br /> SPARGING 35 40 ✓ 2112 LONESTAR <br /> 1 , SAND <br /> ATTACHMENTS (2�) CERTIFICATION STATEMENT <br /> t, the undersigned certlty that this report Is complete and accurate to the hest of my knowledge and belief <br /> Geolpplc Log <br /> Well Construction Diagram NAM{: WOODWARD DRILLING <br /> (PERSON FIRM OR CORPORATION) (TYPED OR PRIMED) <br /> Gecowmaw Logs) P O SOX 336 Rio VISTA CA 94571 <br /> Sa�WYatsr Chemical Anayses CITY <br /> IP <br /> Other <br /> ADDRESS <br /> ATTACH ADDITIONAL INFORMATION IF IT EXISTS Sigrid In Yrl4A <br /> MAY 16,2002 710079 <br /> WILL DRILL HORIZED REPRESENTATIVE DATE SIGNED C 57 LICENSE NUMfJER <br /> DM R 188 REV 11 87 IF ADDITIONAL SPACE IS NEEUD USE NEXT CONSECUTIVELY NUMBERED FORM <br />