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<br /> File Original with DWR State of California DWR Use Ont -Do Not Fal In
<br /> Well Completion Report
<br /> Page 1 of 1 Refer to instruction Pamphlet
<br /> Owner's Well Number AS-6 No. e0168925 -I—�Sta—te well-N�umber/Site�Number T—
<br /> �L1L_L_ W_J—L�
<br /> Date Work Began 10/08/2012 Date Work Ended 10/19/2012 Latitude LN W
<br /> Lon itude
<br /> Local Permit Agency San Joaouin County Environmental Health Department
<br /> Permit Number 65824 Permit Date 10/2/12 APN/TRS/Other
<br /> Geologic Log ell Owner
<br /> Orientation OVertical 0Horizontal OAngle Specify Name Chevron
<br /> Drilling Method Hollow Stem Auger Drilling Fluid Mailing Address 6101 Bollinger Canyon Rd
<br /> Depth from Surface Description
<br /> Feet to Feet Describe material,grain size,color,etc city San Ramon State CA 7iE 94583
<br /> 0 6 Silty clay,dark brown,dry,clay and concrete Well Location
<br /> RIP RAP(fill) Address 508 West Charter Way
<br /> 6 10 Silty clay, light brown,firm, moist, native soil. City Stockton County San Joaquin
<br /> 10 15 Silty sand, reddish brown,fine-grained, loose, Latitude N Longitude ____yv
<br /> moist. Deq. Min. Sec. Dao, Min. Sec.
<br /> 15 20 Sand, brown,fine-grained, loose,moist. Datum Decimal Lat, Decimal Long.
<br /> 20 25 Silty clay, pale greenish gray, low plasticity, APN Book 165 Page 040 Parcel 16
<br /> firm to stiff,wet. Township Ran a Section
<br /> 25 30 Silt, pale greenish gray,soft to loose,wet,coarse Location Sketch Activity
<br /> Sketch must De Orewn D bona after form is rintetl.
<br /> Silt. � New Well
<br /> North
<br /> 30 132 Clay, pale greenish gray, low plasticity,firm to stiff, O Modification/Repair
<br /> O Deepen
<br /> wet. O Other
<br /> 30 35 Clay, pale greenish gray, medium plasticity, O Destroy
<br /> Des<nbe nmsedmes and meters
<br /> firm to stiff,wet. under veoloolc loD•
<br /> Planned Uses
<br /> O Water Supply
<br /> ❑Domestic El Public
<br /> 3 ru ❑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 /> nwsvme u.ms<nbeas,.�<s el.eno-em meas,euflanes.r,-1 O Vapor Extraction
<br /> sna m,s_nemen useeadmmsi pane„ne<essu.v O' Other A Spence
<br /> via o ee.aur.m.m<um i.re
<br /> Water Level and Yield of Completed Well
<br /> Depth to first water 20 (Feet below surface)
<br /> Depth to Static
<br /> Water Level (Feet) Date Measured
<br /> Total Depth of Boring 35 Feet Estimated Yield` (GPM) Test Type
<br /> Test Length (Hours) Total Drawdown (Feet)
<br /> Total Depth of Completed Well 32 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 Feel Inches Inches Inches Inches Feet to Feet
<br /> 0 2$ 110 1 Blank I PVC Sch.40 1 12 1 1 0 24 Cement
<br /> 28 30 10 screen PVC Sch.40 2 0.020 24 26 Bentonite
<br /> 30 32 10 Blank Sump 2 26 33 Filter Pack #3 sand
<br /> 33 35 Bentonite
<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 /> ❑ Geophysical LO Person,Firm or Corporation
<br /> g(5) 14110 Cach ilia ROat Yo CA 95695
<br /> ❑ Soil/Water Chemical Analyses Aaaresa c slate zip
<br /> ❑� Other Site Mao Sig 2/14/13 953646
<br /> Attach additional information it it exists. -57 Licensed Water Well Contractor Date Signed C-57 License Number
<br /> DWR 188 REV,112006 fADDITIONAI SPACE 19 NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM
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