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1 <br /> ORIGINAL STATE OF CALIFORNIA DWR USE ONLY — D NOT FILL IN <br /> File with DWR WELL COMPLETION REPORT <br /> Page__]__-ofd_ Refer to Instruction Pamphlet STATE WELL NO/STATION NO <br /> Owner's Well No SIP-15C No 749252 <br /> LATITUDE D LONGITUDE <br /> WWork Began FEBRUARY 15.2002 , Ended FEBRUARY 15102..._. <br /> cat Permit Agency San Joaquin County Public Health Services-Environmental Health Div APNlTRSlOTHER <br /> Permit No 28821 Permit Date__—.FEBRUARY 8,2002 <br /> GEOLOGIC LOG I IWELL OWNER <br /> ORIENTATION (.t) ✓ VERTICAL -HORIZONTAL -ANGLE _(SPECIFY) NameUNOCAL CORPORATION <br /> DRILLING Hollow Steam Auger___ NONE Mailing Address 8788 ELK GROVE BOULEVARD BUILDING 3 STE 15 <br /> DEPTH FROM METHOD FLUID g <br /> SURFACE DESCRIPTION ELK GROVE CA 95624 <br /> FI to Ft Describe material grain size, calor etc CITY <br /> WELL <br /> ZIP <br /> ELL LDCATION <br /> 0 r 40 i THIS WELL WAS INSTALLED WITHIN FIVE FEET Address 437 EAET MINER AVE. (SIDEWALK 505 N,CALIFORNIA 5D <br /> OF WELL SP-6A,AND WAS NOT LOGGED City <br /> t OR SAMPLED County <br /> APN Book Page Parcel <br /> I I Township Range Section <br /> Latitude_ I I NORTH Longitude. I -_— WEST <br /> DEG MIN SEC DEG MIN SEC <br /> r I LOCATION SKETCH ACTIVITY { ) <br /> 1 r <br /> NORTH ✓ NEW WELL <br /> I I � fD�l !A ODIFICATIONIREPAIR <br /> r r I Wl� — Deepen <br /> r'– — Other(Specify) <br /> r I <br /> r i DESTROY(Describe <br /> Procedures and Materials <br /> I I Under GEOLOGIC LOG") <br /> I I 66 WAR PLANNED <br /> TENEESUPPLUSES (.:L) <br /> I I <br /> I'1 Domestic Public <br /> Irrigation Industrial <br /> I I • ` MONITORING�. <br /> I I <br /> TEST WELL <br /> CATHODIC PROTECTION <br /> I r <br /> r <br /> HEAT A S 1 '/* A UE. EXCHANGE DIRECCTTPUSH <br /> �..._ <br /> SH <br /> r INJECTION <br /> r r VAPOR EXTRACTION <br /> t <br /> OUTH SPARGING✓ <br /> 1 ' <br /> Ilhestmte ur Describe Ihsinnce r f Well from Roark Buildings REMEDIATION <br /> Feizces Rrt.en etc and atincli a Map Ilse additrmtal gayer if OTHER(SPECIFY) <br /> necessanj PLEASE BE ACCURATE&COMPLETE <br /> I WATER LEVEL & YIELD OF COMPLETED WELL <br /> 1 1 DEPTH TO FIRST WATER (Ft) BELOW SURFACE <br /> I r <br /> I I DEPTH OF STATIC <br /> WATER LEVEL (Ft)8 DATE MEASURED <br /> I t ESTIMATED YIELD' (GPM) & TEST TYPE <br /> TOTAL DEPTH OF BORING 40 (Feet) TEST LENGTH (Hrs)TOTAL.DRAWDOWN (Ft) <br /> TOTAL DEPTH OF COMPLETED WELL 40 (feet) 'May not be representatrve of a well's ion -term yield <br /> DEPTH BORE CASING (S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE HOLE TYPE IzQ FROM SURFACE TYPE <br /> DIA z WM I INTERNAL GAUGE SLOT SIZE CE- BEN <br /> (inches) z w z► 4 GRADE DIAMETER OR WALL IF ANY MENT 7ONITE FILL FILTER PACK <br /> Ft to Ft (Inches) THICKNESS (Inches) Ft to Ft (�) (.:n) O (TYPE/SIZE) <br /> 0 i 375 8 Vi PVC 075 0 I 30 ✓ <br /> 375 I 40 8 ✓ MICRO 30 I 35 ✓ <br /> SPARGING 35 i 40 ✓ 2112 LONESTAR <br /> SAND <br /> i <br /> i <br /> ATTACHMENTS (.:L) CERTIFICATION STATEMENT <br /> I, the undersigned,certify that this report Is complete and accurate to the best at my knowledge and belts <br /> Geologic Loy <br /> well Construction Diagram NAME WOODWARD DRILLING <br /> (PERSON FIRM OR CORPORATION) (IYPED OR PRINTED) <br /> Geophysical Log(s) <br /> SCIVWater ChemlCat Analyses P O BOX 336 RIO VISTA CA 94571 <br /> ADDRESS CITY STATE IIP <br /> Other <br /> ATTACH ADDITIONAL INFORMATION IF IT EXISTS &pried MAY D 2002 _ 710079 <br /> LL DRIL IIEO RE RESENIA VE GATE SIGNED C-57 LICENSE NUMBER <br /> DMR 188 REV 11 e, IF ADDITIONAL SPACE: IS NEED D, USE NEXT CONSECUTIVELY NUMBERED FORM <br />