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'The free Adobe Reader may be used to view end compi-Afonn. However.software must be p.trchased to complete,saved reuuseeaa savedform <br /> anl Do Not Fill In <br /> File Original with DWR <br /> Stale of California <br /> Well Completion F1'.eport ( ;-T , I I <br /> Page 13 of 16 Rererto Inslruc9on Pempel"I Stale Well Number/Sete Numher W <br /> Owner's Well Number OW-9 No. e0150682 1_ . <br /> _I__ L N _1�— <br /> Latitude Lon <br /> Date Work Began 03/26/2012 Date Work Ended 4Q/2012 ._ <br /> dude <br /> I In CDLnIy Enyinonmenta Health DeDanment _. A...... /Other <br /> Local Permit Agency <br /> Permit Number permit Date 3/5/12 <br /> NA Well Owner <br /> Geologic Lo <br /> Orientation (E)Vertical O Horizontal OAngle Specify Name PenSCO Trust CO Cust Etal <br /> Drilling Method Hollow Stem Au er <br /> Drilling Fluid Bentonite mud Nailing Address PO Box 144 <br /> Depth from Surface Description Clt Linden State CA_Zi 95326 <br /> Feet to Feet Describe material rain size,color,etc <br /> 60 0 Drill,Sam le and Install Well to 30'usin , <br /> Well Loc <br /> well materials listed below. Address 1¢01 Turnoike Road1---W <br /> C ty Stockton <br /> Latitude N LoecMin. Sec.C stum Decimal Lat. <br /> AIN Book 165 Page 0407 <br /> TDwnshi Ran a Section <br /> Location Sketch Activi <br /> Sketch must be drawn by hand after roan Is prnted l 17 New Well <br /> North 0 Modification/Repair <br /> 0 Deepen <br /> 0 Other <br /> — <br /> 0 Destroy <br /> ompe paem„es ane a.ter'aa <br /> under'GEOLOGIC LOG' <br /> FORemediation <br /> lanned Uses <br /> ter Supply <br /> omestic ❑Public <br /> wrigation ❑Industrial <br /> hodic Protection <br /> watering <br /> at Exchange <br /> ction <br /> nitoring <br /> 0 Sponging <br /> 0 Test Well <br /> South Q Vapor Extraction <br /> II.en..e aa..nd att.endia.bmn.cpe dxlwee.11dRaommonm.iapaper I nexe,.laa.naes <br /> ' Other <br /> Plesae ba¢curaN and can late. <br /> dater Level and Yield of Completed Well <br /> Depth to first water (Feet below surface) <br /> Depth to Static Feet <br /> Water Level (Feet) Date Measured <br /> Total Depth of Boling 66 Feel Estimated Yield' (GPM) Test Type <br /> 'fest Length (Hours) Total Drawdown__(Feet) <br /> Total Depth of Completed Well 60 Feet ^Ma not be representative of a well's Ion term field. <br /> Casings Annular Material <br /> Depth from Borehole Wall Outalde roan Slot Size Depth from <br /> al <br /> Surface Diameter Type Thickness Diameter 'Type If Any Surface <br /> Description <br /> Materi <br /> Inches Inches Inches Feet to Feet <br /> Feet to Fast Inches 3/4 Microporus 60 56 Filter Pack #2/16 <br /> 60 58 8 Screen Sparge Point 5654 Bentonite Chips <br /> 58 0 8 Blank PVC Sch.40 3/4 <br /> 54 0 cement Portland type I/II <br /> Attachments Certification Statement <br /> t <br /> ❑ Geologic Log I,the undersigned,certify that th s report is complete and accurate to the best of my knowledge and belief <br /> [3Well Construction Diagram Name All Well Abandonment, <br /> Person.Finn or Corporation <br /> ❑ Geophysical Log(s) 9245 Beatty Drive Suite A^ f.-SacrameCity nto s 95826 Zip <br /> ❑ SoillWater Chemical Analyses <br /> Address Signed Sig4/25/2012 848359 <br /> O Other Site Mao -C-57 ucensedw5f 90 ntractor Date Signed C-57 License Number <br /> Atlach additional information ifit exists. <br /> OWR 188 REV.120D6 IF ADDITIONAL SPACE IS NEEDED.USE NEXT CONSECUTIVELY NUMBERED FORM <br />