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'The free Adobe Reader maybe used to view and com0is form. However,software must be purchased to complete,0and reuse a saved form. <br /> File Original with DWR State of California DWRUseonl —Do Na Fillln <br /> Pa1 of 1 Well Completion Report <br /> Page Refer to Insbuction Pamphlet <br /> Owner's Well Number VE-3 No. e0169459 State Well Number/Site Number ,-� <br /> Date Work Began 10/08/2012 Date Work Ended 10/19/2012 �� I I—I--�–�–L– <br /> Latitude Longitude <br /> Local Permit Agency San Joaouin County Environmental Health Denartm nt <br /> Permit Number 65824 Permit Date 10/2/12 APN/TRS/other <br /> Geologic LogWell 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,at City San Ramon StateCA 71e 94583 <br /> 0 4 Silty clay, dark brown, loose, da concrete fill Well Location <br /> material. Address 506 West Charter Way <br /> 4 10 Silt, light brown,loose to soft,moist, native soil. City Stockton County San Joaquin <br /> 10 15 Silty Clay, pale grayish brown, low plasticity,firm, Latitude N Longitude_ w <br /> moist, iron oxide staining. Dec. Min. sag- oep. Min. Sec. <br /> 15 17 Poorly graded sand with silt,yellowish brown,fine Datum Decimal Lat. Decimal Long. <br /> to medium sand-grained,loose, moist. APN Book 165 Page 040 Parcel 16 <br /> Townshi Ran a Section <br /> Location Sketch Activit <br /> Sketch must be arewnb hentl deer fano is rimed. Q New Well <br /> Nonh <br /> O Modification/Repair <br /> O Deepen <br /> O Other <br /> - <br /> 0 Destroy <br /> omen'. <br /> ,,,der OLOG <br /> aaOLoiaGIC am toc <br /> Planned Uses <br /> O Water Supply <br /> ❑Domestic []Public <br /> 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 /> w..rrem.a.>onw aeanu m.an,.m tom.. <br /> Wine,ren. G Vapor Extraction <br /> v ..ta..na.n..n.mea ux aaamwn.iwre,an.n....n Q Other <br /> luo ne sau..m.ne cwn Lt.. <br /> ater 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 17 Feet Estimated Yield (GPM) Test Type <br /> Total Depth of Completed Well 17 Feet Test Length (Hours) Total Drawdown.(Feet) <br /> Way 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 Feet Inches Inches Inches Inches Feet to Feet <br /> 0 12 10 1 Blank PVC Sch.40 1 14 1 1 0 $ Cement <br /> 12 17 10 Screen PVC Sch.40 14 0.020 8 11 Bentonite <br /> 11 17 FllterPack #3 sand <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 5 Person Firm or Corporahan <br /> 9( ) 14110 C evilla R a Yolo CA 95695 <br /> ❑ Soil/Water Chemical Analyses Address cin slate zi <br /> ❑+ Other Site Mai) Si d 2/14/13 953646 p <br /> Attach additional information M it exists. .57 Licensed water well Contractor Date Signed C-57 License Number <br /> DWR 188 REV.1Q006 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />