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'The free Adobe Reader may be used to view and comps form. However,software must be Purchased to complete, ntl reuse a saved form.
<br /> File Original with DWR State of California DWR Use OM —Do Not Fill In
<br /> Page 1 of 1 Well Completion Report
<br /> Refer to lnsbuction Pamphlet
<br /> Owner's Well Number AS-10 No. e0169420 State Well NState Well Number/Site Number �I
<br /> Date Work Began 10/08/2012 Date Work Ended 10/19/2012
<br /> Latitude Lon Itude
<br /> Local Permit Agency San Joag lin County Fnyjr.Q0MVntaI Health Department
<br /> Permit Number 65824 Permit Date 10/2/12
<br /> APNII Kb/Other
<br /> Geol is Lo Wel— l
<br /> Orientation (2)Vertical 0Horizontal OAngle Specify Name Chevron
<br /> Owner
<br /> Drilling Method Hollow Stem Au er Drilling Fluid
<br /> Depth from Surface Description Mailing Address 6101 Bollinger Canyon Rd
<br /> Feet w Feet Describe material rain size,color,etc Cit San Ramon State CA Zi 94583
<br /> 0 15 1 Silty clay,gray,soft moist. Well Locatlon
<br /> 5 110 1 Silt, light brown, loose, moist. Address 508 West Charter Way
<br /> 10 115 1 Silty silt,medium plasticity,soft, moist. City Stockton County San Joaquin
<br /> 15 25 Clayey silt,greenish gray, low plasticity, medium Latitude
<br /> N Longitude �yy
<br /> plasticity,Iron oxide staining. Dea. Min. Sec. Oen. Min. Sec.
<br /> 25 130 1 Silt,dark gray, non plastic, iron oxide staining. Datum Decimal Lat. Decimal Long.
<br /> 30 132 Silty fine sand,dark gray, soft,wet, moist. APN Book 165 Page 040 Parcel 16
<br /> 32 133 1 Fine sand,gray, loose,wet. Township Ran a Section
<br /> 33 134 1 Clayey silt, light brown,medium plasticity,firm. Location Sketch Activit
<br /> 34 35 Clay with silt,light brown,high plasticity,soft, sketUrmastbedrawnb handeflerronnfa meo. O New Well
<br /> North
<br /> moist. 0 Modification/Repair
<br /> 35 37 1 Silt with clay, light brown,high plasticity,soft, O Deepen
<br /> O Other
<br /> moist,gray, hard. 0 Destroy
<br /> 37 39 Clay,dark gray, high plasticity, ofirm to hard, moist. o.ecub. namdures an,—I.nw,
<br /> .ne.,cwtocic Inc'
<br /> Planned Uses
<br /> 0 Water Supply
<br /> ❑Domestic E3 Public
<br /> W ❑Irrigation ❑Industrial
<br /> 0 Cathodic Protection
<br /> 0 Dewatering
<br /> 0 Heat Exchange
<br /> 0 Injection
<br /> 0 Monitoring
<br /> O Remediation
<br /> 0 Sparging
<br /> South 0 Test Well
<br /> Iiw.o-na.rb.,cnb.dmmanceol wan r,.m ro.aa a.. ns,,1-- 0 Vapor Extraction
<br /> .aa ana,b.m.o u,a aaaa,onai pap„,rna,e.:arY (� Other
<br /> Air SDaroe
<br /> vi....b..<.or f..nb a.m mt,
<br /> Water Level and Yield of Completed Well
<br /> Depth to first water 30 (Feet below surface)
<br /> Depth to Static
<br /> Water Level (Feet) Date Measured
<br /> Total Depth of Boring 39 Feet Estimated Yield” (GPM) Test Type
<br /> Total Depth of Completed Well 39 Feet Test Length (Hours) Total Drawdown_(Feet)
<br /> *May not be representative of a well's Ion term field.
<br /> Casings Annular Material
<br /> Depth from Borehole TWall 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 to Feet
<br /> 0 34 10 Blank PVC Sch.40 2 0 30 Cement
<br /> 34 36 10 Screen PVC Sch.40 2 0.020 30 32 Bentonite
<br /> 36 39 10 Blank Sumo 2 32 39 Filter Pack #3 sand
<br /> ELI I
<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 Log(s) Person,Firm or Corporaton
<br /> IJSoil/Water Chemical Analyses 14110 Cac aloe Road Yolo a CA 95695
<br /> 0 Sig
<br /> Other Site Mal) n Slate zip
<br /> 2/14/13 953646
<br /> Anacn atl0ilional iMormation if it exists. s Licensed Water Well Contractor Date Si ned C-57 License Number
<br /> DWR 188 REV.12006 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM
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