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TRIPLICATE STATE OF CALIFORNIA DWR USE ONLY — DO NOT FILL IN <br /> Owner's'Copy WELL COMPLETION REPORT I I 1 1 1 1 1 I 1 1 1 <br /> Prge 2 of 3 Refer to Instruction Pamphlet STATE WELL NO./STATION NO. <br /> Owner's Well No. 1 NO. 723443 I-1 ❑ I I I I <br /> Date Work Began 08/16/99 Endedl2/31/99 LATITUDE LONGITUDE <br /> Local Pemiit Agency SAN JOAOUINCO EHD I I 1 1 1 11 1 1 1 I <br /> Permit No. 020259 Penn it Date 08/17/99 APNrrRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(✓) VERTICAL HORIZONTAL — ANGLE (SPECIFY) Name W D O INC. <br /> DRILLING REVERSE WATER Mailing Address23950 S. CHRISMAN RD. <br /> DEPTH FROM METHOD FLUID TRACY CA 95376 <br /> FA DESCRIPTION - <br /> Ft. to Ft. Describe material, grain, size, color, etc. CITY STATE ZIP <br /> 277 350 CLAY WELL LOCATION <br /> _ Address APRICOT LANE <br /> 350: 420: BLUE CLAY/SHALE City TRACY CA- <br /> 420' 537'CLAY/BLUE,BROWN SHALE County SAN JOAQUIN <br /> 537 538 GRAVEL APN Book 248 Page 07 Parcel 12 <br /> 538 542:CLAY Township 0 RangeO Section 0 <br /> 542` 560:CLAY STREAKS/GRAVEL/SHALE Latitude I <br /> 560 564_;CLAY DEG. MIN. SEC. DEG. MIN. SEC, <br /> 564. 582 GRAVEL/ROCK/CLAY LOCATION SKETCH ACTIVITY (v ) <br /> NORTH NEW WELL <br /> 582 _596 CLAY/GRAVEL STREAKS MODIFICATION/REPAIR <br /> 596 605 GRAVEL -- Deepen <br /> 605,__ 635 CLAY/GRAVEL STREAKS ---Other(Specify) <br /> 635'. 639 GRAVEL _ DESTROY(Describe <br /> 639'~ 660 CLAY/GRAVRL STREAKS Procedures and Materials <br /> _ Under"GEOLOGIC LOG` <br /> 660 663 GRAVEL PLANNED USES(�) <br /> 60-67b CLAY WATER SUPPLY <br /> 670 696 GRAVEL/ROCK/CLAY STREAKS ~ W — Domestic— Public <br /> W _ Irrigation _ Industrial <br /> 696 755 CLAY 3 w <br /> MONITORING— <br /> 755 770 GRAVEL/ROCK TEST WELL <br /> 770 779 CLAY ATHODIC PROTECTION <br /> 779' 81_ CLAY 2 GRAVEL/HARD ROCK HEAT EXCHANGE <br /> 812 DIRECT PUSH <br /> 830 <br /> INJECTION <br /> 830 832 GRAVEL/ROCK <br /> VAPOR EXTRACTION <br /> 832 863 CLAY/GRAVEL STREAKS SPARGING <br /> 863 867 GRAVEL SOUTH REMEDIATION_ <br /> 111wirale or Describe Dislanceof Wel/from Roads.Buildings. <br /> 867 895,CLAY/GRAVEL STREAKS Fences,Rivers,etc. and attach a map. Use additional paper if <br /> necessary.PLEASE <br /> OTHER(SPECIFY) <br /> 895 _ 903 GRAVEL/ROCK BE ACCURATE & COMPLETE. <br /> 903 907,CLAY WATER LEN*EL&YIELD OF COMPLETED WELL <br /> 907 915- ROCK DEPTH TO FIRST WATER— --- (Ft.)BELOW SURFACE <br /> 915 935:CLAY/ROCK STREAKS DEPTH OF STATIC <br /> 935 940: ROCK STREAKS WATER LEVEL (Ft.)&DATE MEASURED - <br /> ESTIMATED YIELD ' 0 (GPM)& TEST TYPE <br /> FWAL DEPTH OF BORING 970 (Feet) TEST LENGTH (Hrs.)TOTAL DRAWDOWN 0 (Ft.) <br /> TOTAL DEPTH OF COMPLETED l'TL.I.0 (Feet) Mar not be representative of a well's long-term yield. <br /> DEPTH CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE BORE HOLE — <br /> YPE T ✓) FROM SURFACE TYPE <br /> DIA. x w a MATERIAL/ INTERNAL GAUGE SLOT SIZE CE- BEN- FILTER PACK <br /> (Inches) Z w p a GRADE DIAMETER OR WALL IF ANY MENT TONIT FILL <br /> Ft. to Ft. m U U (Inches) THICKNESS (Inches) Ft. to Ft. (TYPE/SIZE) <br /> ro — 00 <br /> U. <br /> ATTACHMENTS CERTIFICATION STATEMENT <br /> Geologic Log I,the undersigned,certify that this report is complete and accurate to the best of my knowledge and belief. <br /> Well Construction Diagram NAME CALWATER DRILLING CO., INC. <br /> Geophysical Log(s) (PERSON,FIRM,OR CORPORATION)(TYPED OR PRINTED) <br /> — Soil/Water Chemical Analysis 300 S Kilroy Rd. TurIOCk CA 95380 <br /> — Other ADDRESS CITY STATE ZIP <br /> 08/06/01 434218 <br /> ATTACH ADDITIONAL INFORMATION,IF IT EXISTS. Signed _ <br /> WELL DRILLER/AUTHORIZED REPRESENTATIVE DATE SIGNED C-87 LICENSE NUMBER <br /> DWR 188 RE%'.11-97 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />