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1 -The free Adobe Reader may be used to view and complete this form. However,software must be purchased to complete,save,and reuse a saved form. <br /> File Original with DWR State of California DWR Use Only–Do Not Fla In <br /> Well Completion Report --T� — T� <br /> Page 1 Of 4 ROW.ln.recttoo PamPhkl �I I I- <br /> T I I <br /> I�State Well NumbenS—�ire Number� <br /> Owner's Well Number MW-7 No- 80101003 ( <br /> l TT L_J <br /> Date Work Began 10/26/2009 Date Work Ended 10126/2009 Latitude Longitude <br /> Local Permit Agency San Joanuin County Environmental Health Department <br /> Permit Number 057999 Permit Date 8/7/09 APNITFN Ner <br /> Geologic Log Well Owner <br /> Orientation OVertical 0Horizontal OAngle Spedty Name CEMC <br /> 1 Drilling Method Hollow Stem Auger Drilling Fluid Mailing Address 6111 Bollinger Canyon Road,BR Y3432 <br /> Depth from Surface Description San Ramon �i 94583 <br /> Fact m Feet Describe materiel, rain size Wor,etc Cit State CA <br /> 0 32 Neat cement grout Well Location <br /> ' Address 26501 Banta Road <br /> City Lvoth County San Joaquin <br /> Latitude _ N Longitude __-_—_WDen. Min see. Dee. Mn. W. <br /> Datum Decimal Let. Decimal Long. <br /> APN Book 2,52 Page 010 Parcel 06 <br /> Townshl CRan a 5E Section 35 <br /> Location Sketchvity <br /> ISkelch must bit drawn hand afefarmla entad. New Wail <br /> North O Mod cation/Repair <br /> O Deepen <br /> O Other <br /> — O Destroy <br /> undw'GpattCumMWln <br /> dw'GEULUGIU LUG'OW <br /> Planned Uses <br /> Q Water Supply <br /> -_-- - N <br /> [Domestic []Public <br /> 8 w []Irrigation ❑Industrial <br /> O Cathodic Protection <br /> i O Dewatering <br /> O Heat Exchange <br /> O Injection <br /> Monitoring <br /> O Remedlation <br /> ' O Sparging <br /> South O Test Well <br /> N,neors.me.rvim..u..rrwx.wsngs,�mre O Vapor Extraction <br /> sarv.� 0 Other <br /> Water Level and Yield of Completed Well <br /> Depth to first water (Feet below surface) <br /> Depth to Static <br /> Water Level 20 (Feet) Date Measured 10/28/2009 <br /> Total Depth of Boring 32 Feet Estimated Yield` (GPM) Test Type <br /> Test Length (Hours)Total Drawdown (Feet) <br /> Total Depth of Completed Well 31.11 Feet *May not be representative of a well's Iona term vield. <br /> Casings Annular Material <br /> Depth from Borehole Wall Outside Screen slot Size Depth from <br /> Surface Diameter Type Material 'thickness Diameter Type if Any Surface Fill Description <br /> Feet to Feet Inches Inches Inches) Onchesl Feet to Feet <br /> Attachments Certification Statement <br /> ❑Geologic Log I,the undersigned,car, that this report Is complete and accurate to the best of my knowledge and belief <br /> 11m <br /> Well Construction Diagram Nae RSI Drilling.Ino. <br /> Person,Frrn or Corporaoan <br /> ❑Geophysical Log(s) 220 North East Street, Woodland CA 95776 <br /> ❑SoIVWater Chemical Analyses a raxi city smm zp <br /> El Other Sita Mao showing well location Signe 11/12/09 802334 <br /> 4itawadditionuoint.tiot.aft.cm, O8710cansM alervr amracmr Date Signed C-57 License Number <br /> LM 188 REV.12Use IF ADDITIONAL SPACE IS NEE uSE NEXT CONSECUTWELY NUMBERED FORM <br />