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ORIGINAL STATE OF CALIFORNIA <br /> G Fila with DWR WELL COMPLETION REPORT <br /> ' page 1 of 1 Refer to Insrrucrton Pampblet STATE WELL HO r9TAT1oH No <br /> own is Well No MW1 through MW7 No 495497 <br /> 2te Work Began IZ4195 Ended---L/17/95 LATkDE ❑ LONGITUDE <br /> Local Permit Agency San--JQAquin-Local Health District <br /> Permit No n/a Permit Date 11/10/94 <br /> GEOLOGIC LOC WELL OWNER <br /> ORIENTATION (z:j) x VERTICAL _ HORIZONTAL _ANGLE _(SPECIFY) Name <br /> DEPTH FROM DEPTH TO FIRST W 1TEIt (Ft) BELOW SURFiC£ Mailing Address P-0- Box 5155 <br /> SURFACE DESCRIPTION San Ramon CA 94583 <br /> Ft to Ft Describe matertal grans size color etc #09WELL LOCATION <br /> 50 STATE ZIP <br /> Address 2835 Navy Drive <br /> City StoCkjgn. CA - <br /> County San Joaquin Count <br /> APN B,ak 145 Page 030 Parcel 09 <br /> or <br /> Township flange Sec.tiun <br /> OnJanuary 4 and 17 1995 the Latitude - t NORTH Longitude WEST <br /> Tl monitoring We115 DEG MIN SEC DEG MIN SEC <br /> spyen LOCATION SKETCH ACTIVITY (!through )— <br /> MW7 were destroyed NORTH _NEW WELL <br /> by fully drilling out the existing MODIFICATIOWREPAIR <br /> well spalr2. 11 casinLrs. and SEE ATTACHED SITE PLAN "Deepen <br /> filter pack sand materials. The AND LOCATION MAP. _Other(Spec,ty) j <br /> hcirfholes-were then -fuUy sealed <br /> WAh neat cement Xrout, which was DESTROYIDescnba <br /> planed from the bottom f each Under GEoteOGICLOG'S <br /> barjnX to the xxx surface, In one N PLANNED USE(S) <br /> tu <br /> nnnt-t,�Unus pour- 3 W MONITORING <br /> WATER SUPPLY <br /> Domestic <br /> ' 1 <br /> Public <br /> irrigation <br /> Intlustnal <br /> TEST WELL <br /> _ CATHODIC PROTEC <br /> SOUTH TION <br /> Illustrate or Dewnbe Datance of Well from Landmarks r OTHER(Speeity) <br /> such as Roads $urldtngs Fences Rtuers etc <br /> PLEASE BE ACCURATE & COMPLE'T'E <br /> M THODRILLING <br /> Hollow-stem auger FLUID n/a <br /> WATER LEVEL k YIELD OF COMPLETED WELL <br /> DEPTH OF STATIC <br /> WATER LEVEL (Ft} & DATE MEASURED <br /> ESTIMATED YIELD* (GPM) & TEST TYPE <br /> TOTAL DEPTH OF BORING (Feet) TEST LENGTH (Hrs) TOTAL DRAWDOWN (Ft) <br /> TOTAL DEPTH OF COMPLETED WELL (Feet) 'Mav not be represensanve of a well's lnng-term yield <br /> DEPTH CASINC(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE HOLE TYPE (✓ FROM SURFACE TYPE <br /> INTERNAL GAUGE SLOT SIZE <br /> DIA C a o a MATERIAL! C2 BEN <br /> {inches) c z� a DIAMETER OR WALL IF ANY FILTER PACK <br /> s o� GRADE HENT BEN <br /> FILL <br /> Ft to Ft m N = (Inches) THICKNESS (inches) Ft to Ft (� ) {� ) (� ) (TYPE/SIZE) <br /> N/A 'N/A <br /> ATTACHMENTS (!) CERTIFICATION STATEMENT <br /> I the undersigned certify that this report IS Complete and accurate to the hest of my knowledge and belief <br /> Geologic Log <br /> Well Construction Diagram NAME WOQ!jMZ8j! M1h CO. <br /> {PERSON FIRM Olt CORPORATION} (TY OR PRINTED) <br /> GeophymcetLogin) <br /> Sod/Water Chemical Analyses <br /> ADDRESS P_C1_ ftnw 336 Rio Vista CA CITY STATE ZIP <br /> X OthM <br /> oCa loll a#] signed581639 <br /> ATTACH ADpfTTONAL 1NFORMATTiON IF f EXISTS S It WELL ORlLL T ��DEIIIESINTAUVE DATE GNE C 5T LICENSE NUMBER <br /> DWR 189 REV 7eo IF ADDITIONAL SPACE IS NEEDED UA41EXT CONSECUTIVELY NUMBERED FORM �`� <br />