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TRIPLICATE STATE OF CALIFORNIA DWR USE ONLY — DO NOT FILL IN <br /> Owner's Copy WELL COMPLETION REPORT V I I I 1 <br /> fake 3 of 3 Refer to Instruction Pamphlet STATE WELL NO./STATION NO. <br /> Owner's Well No. 1 — No.723443 I I ❑I I I I I I�❑ <br /> Date Work Began 08/16/99 Ended12/31/99 LATITUDE LONGITUDE <br /> Local Permit Agency SAN JOAQUIN C'O EHD _ I I I I I <br /> Permit No. 020259 Permit Date 08/17/99 APNTRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(✓) VERTICAL _HORIZONTAL — ANGLE —(SPECIFY) Nwile W D O INC. _ -- — <br /> DRILLING <br /> HOD FLUID REVERSE WATER Mailing Address23950 S. CHRISMAN RD.TRACY CA 95376 <br /> DEPTH FROM METHOD <br /> _ <br /> SURFACE DESCRIPTION - — <br /> Ft. to Ft. Describe material, grain, size. color. etc. CITY STATE ZIP <br /> 940 970:CLAY Address APRICOT LANE ELL LOCATION — <br /> City TRACY CA- <br /> _ County SAN JOAQUIN <br /> APN Book 28 __Page 07 Parcel 12 <br /> Township 0 RangeO Section 0 <br /> Latitude <br /> DEG. MIN. SEC. DEG. MIN. SEC. <br /> – LOCATION SKETCH ACTIVITY (✓) <br /> NORTH NEW WELL <br /> MODIFICATION/REPAIR <br /> -- —Deepen <br /> —Other(Specify) <br /> DESTROY(Describe <br /> Procedures and Materials <br /> Under"GEOLOGIC LOG" <br /> PLANNED USES(Z) <br /> WATER SUPPLY <br /> F F- _ Domestic_— Public <br /> WQ __ Irrigation _ Industrial <br /> 3 w <br /> MONITORING <br /> TEST WELL <br /> ATHODIC PROTECTION <br /> HEAT EXCHANGE <br /> DIRECT PUSH <br /> _ INJECTION <br /> VAPOR EXTRACTION _. <br /> SPARGI NG_ <br /> SOUTH REMEDIATION— <br /> Illustrate <br /> EMEDIATION_Illustrate or Describe Distance ofWelljromRoads.Buildings. <br /> Fences,Rivers,etc. and attach a map. Use additional paper if OTHER(SPECIFY)— <br /> - <br /> necessary.PLEASE BE ACCURATE & COMPLETE. <br /> WATER LEVEL&YIELD OF COMPLETED WELL <br /> -- DEPTH TO FIRST WATER— (Ft.)BELOW SURFACE <br /> - DEPTH OF STATIC <br /> WATER LEVEL (Ft.)&DATE MEASURED <br /> -- ESTIMATED YIELD ' 0 (GPM)& TEST TYPE_ <br /> TOTAL DEPTH OF BORING 970 (Feet) TEST LENGTH (Hrs.)TOTAL DRAWDOWN 0 (Ft.) <br /> TOTAL. DEPTH OF COMPLETED WELL 0 (Feet) Mar not be representative o a well's long-Ie-rnt yield. <br /> DEPTH CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE BORE- TYPEA/) FROM SURFACE TYPE <br /> HOLE — <br /> - -- DIA. x w a MATERIAL/ INTERNAL GAUGE SLOT SIZE CE- BEN- FILTER PACK <br /> (Inches) Z p a GRADE DIAMETER OR WALL IF ANY Ft. to Ft. MENT TONIT FILL (TYPE/SIZE) <br /> Ft. to Ft. m U ((inches) THICKNESS (Inches) <br /> 00 <br /> ATTACHDIENpS ( 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 /> SoilNvater Chemical Analysis 300 S.KilroyRd. Turlock CA 95380 <br /> ADDRESS CITY STATE ZIP <br /> _— Other 08/06/01 434218 <br /> ATTACH ADDITIONAL INFORMATION,IF IT EXISTS. Signed <br /> WELL DRILLER/Al1THORIZEDREPRESENTATIVE DATE SIGNED C57 LICENSE NUMBER <br /> DWR 188 REV.I1-97 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />