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' 'The free Adobe Reader may be used to view and compos form. However,software must be purchased to complete, 0End reuse a saved form. <br /> File Original with DWR State of California 777DIWR Use Onl -Do Not Fill In <br /> Page 1 of 1 Well Completion Report <br /> Referto Instruction PamVnlel <br /> Owner's Well Number AS-7 No. e0168932 �State�well Number/Site�Number <br /> �—�-� <br /> Date Work Began 10/08/2012 Date Work Ended 10/19/2012 <br /> Latitude Lon Rude <br /> Local Permit Agency San Joag lin County nyirgnm ntal Health naingirtment <br /> Permit Number 65824 Permit Date 10/2/12 <br /> APN/TRS/Other <br /> Geologic Loa Well Owner <br /> Orientation OVertical 0Horizontal OAngle Specify Name Chevron <br /> Drilling Method Hallow Stem Au er Drilling Fluid <br /> Depth from Surface Description Mailing Address 6101 Bollinger Canyon Rd <br /> Feet to Feet Describe material rain size color,etc Cil San Ramon State CA 7 94583 <br /> 0 6 Silt clay, loose,dry, silt claywith concrete Well Location <br /> Rip Rap. Address 508 West Charter Way <br /> 6 16 Silt, light brown,loose to soft, moist,native soil. City Stockton San Joaquin <br /> 16 25 Silt Clay, pale greenish gray,color change,odor, County <br /> Latitude N Longitude <br /> loose to soft,moist. Dea. Mm. sac. Dea. Mie. Sec �N <br /> 25 30 Silt,pale greenish,gray,loose to soft,wet,odor, Datum Decimal Lat. Decimal Long. <br /> Staining. APN Book 165 Page 040 Parcel 16 <br /> 30 32 Clay with silt, pale greenish gray, medium township Ran a Section <br /> plasticity,dense,wet. Location Sketch Activit <br /> Sketch must be drawn b hand after form is rimed. • New Well <br /> North <br /> O Modification/Repair <br /> O Deepen <br /> O Other <br /> — <br /> 0 Destroy <br /> Describe opudurds and mele(Is <br /> uMer'GEOLOGIC LOG' <br /> Planned Uses <br /> O Water Supply <br /> ❑Domestic []Public <br /> 3 w ❑Irrigation ❑Industrial <br /> O Cathodic Protection <br /> O Dewatering <br /> O Heat Exchange <br /> O Injection <br /> O Monitoring <br /> O Remediation <br /> O Spangling <br /> South O Test Well <br /> uwmrara or aesonea d�duno.of waII from road.,WNng,nomas, O Vapor Extraction <br /> n:emo.and amen.man ua.addmm�d nard„<oao �. Other <br /> .Ira—...1..odeom mm. °'� Air Scarce <br /> Water Level and Yield of Completed Well <br /> Depth to first water (Feet below surface) <br /> Depth to Static <br /> Water Level (Feet) Date Measured <br /> Total Depth of Boring 32 Feet Estimated Yield (GPM) Test Type <br /> Total Depth of Completed Well 32 Feet Test Length (Hours) Total Drawdown_(Feet) <br /> *May not be re resentative of a well's long term viell <br /> Casinos Annular Material <br /> Depth from Borehole Type Material wall Outside Screen Slot Size Depth from <br /> Surface Diameter Thickness Diameter Type If Any Surface Fill Description <br /> Feet to Feel Inches Inches Inches Inches Feet to Feet <br /> 0 28 10 Blank PVC Sch.40 2 0 24 cement <br /> 28 30 10 1 Screen PVC Son.40 2 0.020 24 26 Bentonite <br /> 30 32 10 Blank Sump 2 26 32 Filter Pack #3 sand <br /> Attachments Certification Statement <br /> 11 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 Log(s) Person,Firm or Corporation <br /> ❑ Soil/Water Chemical Analyses Z <br /> MbNEEDEO, <br /> oto ss cit CA 95695 <br /> ❑� Other Site Mal) Sy state zip <br /> /13 953646 <br /> Attach additional Informattion if exists. well contractor Date Signed C-57 License Number <br /> DWR 188 REV.1/2006 IF USE NEXT CONSECUTIVELY NUMBERED FORM <br />