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<br /> r 'The free Adobe Reader may be used to view and comps form. However,software must be purchased to complete, nd reuse a saved form.
<br /> File Original with DWR State of California
<br /> DWR Use Only—Do Not Fill In
<br /> Page 1 of 1 Well Completion Report
<br /> Refer to Instruction Pamphlet State Is Number/She Number
<br /> Owner's Well Number AS-4 No. e0168866 �7�-�
<br /> Date Work Began 10/08/2012 Date Work Ended 10/19/2012 Lati LonLon
<br /> Local Permit Agency San Joaouin County Envirom ntal Health Department
<br /> Permit Number 65824 Permit Date 10/2/12 APN/rRSlOther
<br /> Geologic Log Well Owner
<br /> Orientation OVertical 0Horizontal OAngle specify Name Chevron
<br /> Drilling Method Hollow Stem Auger Drilling Fluid
<br /> Depth from Surface Description Mailing Address 6101 Bollinger Canyon Rd
<br /> Feet to Feet Describe material rain size color,etc City San Ramon State CA Zi 94583
<br /> 0 14 1 silty sand,gray, loose,dry. Well Location
<br /> 4 10 Silty clay,dark brown,dense to hard,dry. Address 508 West Charter Way
<br /> 10 17 Silt, pale greenish gray,soft, moist,staining. City Stockton County San Joaquin
<br /> 17 20 Sand, light brown,fine-grained,loose,dry,odor. Latitude
<br /> N Longitude _ _W
<br /> 20 25 Silty sand with silt, pale greenish gray, oea. Min. Sec. peg. Min. Sec.
<br /> fine-grained,loose, moist,odor. Datum Decimal Lat. Decimal Long.
<br /> 25 30 Silt,dark gray,soft,wet, sheen present,odor, APN Book 165 Page 040 Parcel 16
<br /> staining. Townshi Ran a Section
<br /> 30 31 Well-graded fine sand,dark gray,loose, saturated, Location Sketch-seesse Activity
<br /> odor, staining. 54,summustbadni.b hand akar form nmed. 0 New Well
<br /> Nonh 0 Modification/Repair
<br /> 31 35 Silty sand,dark gray,soft,wet,sheen present. O Deepen
<br /> 35 36 Poorly graded sand,dark gray,fine-grained, O Other
<br /> loose,wet,staining. O Destroy
<br /> De:cew p,00ddmeeendra.t—o6
<br /> 36 38 Silt, dark gray,soft,wet,staining. mMer GEOLOGIC LOG
<br /> Planned Uses
<br /> O Water Supply
<br /> []Domestic ❑Public
<br /> 3 w
<br /> [Irrigation ❑Industrial
<br /> O Cathodic Protection
<br /> O Dewatering
<br /> O Heat Exchange
<br /> O Injection
<br /> O Monitoring
<br /> O Remediation
<br /> O Sparging
<br /> South O Test Well
<br /> uw.ee,eorde.reeo memdcc of well from roads,nmmIe..ren— O Vapor Extraction
<br /> em en.m.m.v.use eaeemoei odoor a oe,ee:.„ De Other Air SDarpe
<br /> ......ehe.car.,e.ne aom Im.
<br /> Water Level and Yield of Completed Well
<br /> Depth to first water 23 (Feet below surface)
<br /> Depth to Static
<br /> Water Level (Feet) Date Measured
<br /> Total Depth of Boring 38 Feet Estimated Yield (GPM) Test Type
<br /> Test Length (Hours) Total Drawdown_(Feet)
<br /> Total Depth of Completed Well 38 Feet 'May not be representative of a well's long term yield.
<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 Inches Feet tG Feet
<br /> 0 34 10 Blank PVC sch.40 1 12 1 1 0 30 Cement
<br /> 34 36 10 screen PVC Sen.ao 2 0.020 30 32 Bentonite
<br /> 36 38 10 Blank Sump 2 32 38 Filter Pack #3 Sand
<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 National EWP. Inc
<br /> ❑ Person,Firm or Corporation
<br /> Geophysical Lo
<br /> Y g(s) 14110 Ca evile Road Yolo CAA 95695
<br /> ❑ Soil/Water Chemical Analyses Address city state zi
<br /> ❑O Other Site Mal) Si d ,/�-- 2/14/13 953646 p
<br /> Attach additional information rc It edsts. C-57 Licensed Water we ontractor Date Signed C-57 License Number
<br /> DWR 188 REV.1=06 IF ADDITIONAL SPACE IS NEEDED,USE NExr CONSECUTIVELY NUMBERED FORM
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