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<br /> File Original with DWR Stale of California DWR Use ON —Do Not FWI In
<br /> Pa1 of 1 Well Completion Report
<br /> 9e Refer to Instruction Pamphlet
<br /> Owner's Well Number AS-12 No. e0169450 St.,.Well�Numlber S1.N�umber —r-I
<br /> Date Work Began 10/08/2012 Date Work Ended 10/19/2012
<br /> on itude
<br /> Local Permit Agency San joaujuin County Environm ntal Health D D^rtm nt
<br /> Permit Number 65824 Permit Date 10/2/12 APNrtRSlothar
<br /> Geoloctic LouWell Owner
<br /> Orientation OVertical 0Horizontal OAngle Specify Name Chevron
<br /> Drilling Method Hallow Stem Auger Drilling Fluid
<br /> Depth from Surface Description Mailing Address 6101 Bollinger Canyon Rd
<br /> Feet to Feet Describe material,grain size,color,etc Cit San Ramon State CA 7ip 94583
<br /> 0 16 1 Silt fine sand, light brown, loose, moist. Well Location
<br /> 6 10 1 Silty clay,gray, non plastic, soft to loose, moist. Address .508 West Charter Way
<br /> 10 11 Silty sand, brown, non plastic,soft, moist. City Stockton County San Joaquin
<br /> 11 15 Clayey silt, brown,non plastic,soft, moist. Latitude
<br /> N Longitude_ W
<br /> 15 20 Silt with clay, brown, non plastic, soft, moist,iron gee. rein. Sec, Dec. Min, Seo.
<br /> oxide staining. Datum Decimal Lat. Decimal Long.
<br /> 20 25 Clayey silt,gray,medium plasticity,firm, moist, APN Book 165 Page 040 Parcel 16
<br /> trace med sand, lite brown mottling. Township Ran a Section
<br /> 25 130 sandy silt, brown, low plasticity, medium plasticity, Location S7r;�2
<br /> AcN
<br /> ylty
<br /> high plasticity, soft,wet. Sketch must be dre.b hdrw WellNorth30 31 Clay, light greenish brown, high plasticity, hard, dification/Repair
<br /> Deepen
<br /> moist. Other31 34 Clayey silt, light greenish brown, high plasticity, stroy
<br /> hard,moist. B1w Pce.1— and malarias
<br /> EOLOGIC LOG34 35 Silt,dark gray, non plastic, hard to firm, moist. lanned Uses
<br /> 35 38 Silty clay,dark gray, medium plasticity, hard to O Water Supply
<br /> firm, moist. El Domestic []Public
<br /> 3 re ❑Irrigation ❑Industrial
<br /> w
<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 /> Iwso-.mo,a..adb.dlamnw Mwell rram roam.bminme=.rams U vapor Extraction
<br /> Ls,z em and mem a map. use aneumnal paper a nacassary 11 OQ Other Air SDame
<br /> PI.—baeccureleene mm lam
<br /> Water Level and Yield of Completed Well
<br /> Depth to first water 25 (Feel 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 /> Total Depth of Completed Well 38 Feet Test Length (Hours) Total Drawdown.(Feet)
<br /> *May not be representative of a well's long termfield.
<br /> Casings Annular Material
<br /> Depth from Borehole Type Material Wail Outside Screen Slot Size Depth from
<br /> Surface Diameter Thickness Diameter Type if Any Surface Fill Description
<br /> Feet to Feet Inches Inches jhnches Inches Feet to Feet
<br /> 0 33 10 Blank PVC Sch.40 2 0 28 Cement
<br /> 33 35 10 Screen PVC Sch.40 2 0.020 28 31 Bentonite
<br /> 35 38 10 Blank Sump 2 31 38 Filter Pack #3 sand
<br /> Attachments Certificatic 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 Corpombon
<br /> 14acherville Road Yolo CA 95695
<br /> ❑ SoilMater Chemical Analyses Address cu
<br /> ❑+ Other Site Map Sig state Zip
<br /> 2/14/13 953646
<br /> Attach additional informe8on Hit exists. -57 Licensed Water Well Contractor Date$I ned D-57 License Number
<br /> DWR 188 REV 1/2006 nDDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM
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