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<br /> File Original with DWR State of California
<br /> DWR Use Only–DO Not Fill In
<br /> Pa1 of 1 Well Completion Report
<br /> Page Refer to Insbucflon Pernphlsl
<br /> Owner's Well Number AS-8 NO- e0169377 �Lane Well umber/Site Number
<br /> Date Work Began 10/08/2012 Date Work Ended 10/19/2012 N w
<br /> Latitutle ude
<br /> Local Permit Agency San Joaquin County Environmental Health Department LonR
<br /> 71
<br /> Permit Number 65824 Permit Date 10/2/12
<br /> APN/TRS/Other
<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 BollinDer Canyon Rd
<br /> Feet to Feet Describe material rain size,color,etc City San Ramon State CA Zi 94583
<br /> 0 5 Silt clay, dark brown, silt claywith ravel and Well Location
<br /> Cement. Address 508 West Charter Way
<br /> 5 10 silt, light brown,loose, moist,native soil. City Stockton County San Joaquin
<br /> 10 15 pale brown, loose, moist, iron oxide staining. Latitude
<br /> N Longitude
<br /> 15 21 Silt,find sand, pale gray,loose, moist,odor, Dea. Min. seo. Dea. Min. sec. w
<br /> Staining. Datum Decimal Lat. Decimal Long.
<br /> 21 30 Silt, pale gray, loose to soft, moist, odor,staining. APN Book 165 Page 040 Parcel 16
<br /> 30 35 silt, pale gray, non plastic,stiff to dense,wet,odor, Township Ran e Section
<br /> staining. Location Sketch Activit
<br /> 35 137 clay, pale gray, medium plasticity,stiff,wet,fat Sketch must be drawn by hand ober form is rimed. O New Well
<br /> North
<br /> clay, odor,staining. O Modification/Repair
<br /> O Deepen
<br /> 37 40 Silt with clay, pale gray, non plastic,soft,wet,odor, O Other
<br /> staining. O Destroy
<br /> ou..n•o,.ue.,...nd m.,.nele
<br /> 40 41 Silty fine sand,fine sand,pale gray, loose to soft, under GEOLoaC Loc
<br /> wet,odor, staining 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 Sparging
<br /> South O Test Well
<br /> Im,..I.,nd...11.eueen—r.,.n r,...d.,b„nams.r. .. O Vapor Extraction
<br /> ro .I end.n.m.... m .,- �e-v ... — QOther Air Scarce
<br /> Water Level and Yield of Completed Well
<br /> Depth to first water 18 (Feet below surface)
<br /> Depth to Static
<br /> Water Level (Feet) Date Measured
<br /> Total Depth of Boring 41 Feet Estimated Yield (GPM) Test Type
<br /> Total Depth of Completed Well 34 Feet Test Length (Hours) Total Drawdown_(Feet)
<br /> *May not be re resentative of a well's long term yield.
<br /> Casings Annular Material
<br /> Depth from Borehole Wall Outside Screen Slot Size De th from
<br /> Surface Diameter Type Material Thickness Diameter Type if Any Surface Fill Description
<br /> Feel to Feet Inches Inches Inches Inches Feet to Feet
<br /> 0 30 10 Blank PVC Sch.40 2 0 26 Cement
<br /> 30 32 10 Screen PVC Sch.40 2 0.020 26 28 Bentonite
<br /> 32 34 10 Blank Sump 2 28 35 Filter Pack #3 sand
<br /> 35 41 Bentonite
<br /> Attachments Certificatio=ofmy
<br /> ❑ Geologic Log I,the undersigned,certify that this report is complete of my knowledge and belief❑Well Construction Diagram Name National EWInc❑Geophysical Log(s) Person,Firm or Corporation❑ Soil/Water Chemical Analyses 14110 Cac ee Road oto 95695ss
<br /> ❑O Other Site Mao Signe I,pANacc'hadditidnalinfdrmalion Nit eusl5. C-5]Uoerved water well Contractor 7 License Number
<br /> DWR 188 REV.1,2006 IF DITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM
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