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<br /> File Original with DWR State of California DWR Use Onl —Do Not Fill In
<br /> Page 1 of 1 Well Completion Report
<br /> Refer to Insauctlon PampMet
<br /> Owner's Well Number VE-6 No. e0169539 ���TSt—atee Wel�l Number/Site Number
<br /> Date Work Began 10/08/2012 Date Work Ended.10/19/2012 EE�J
<br /> Lati[utle Lon itutle
<br /> Local Permit Agency San JoaoLin CDLnty Environmental Health Department
<br /> Permit Number 65824 Permit Date 10/2/12
<br /> APN/TRB/Other
<br /> Geolo ie LogWell 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 Bollinger Canyon Rd
<br /> Feet to Feet Describe material rain size color,etc Cit San Ramon State Chi 94583
<br /> 0 6 1S11tv clav with ravel,dark, brown, loose,dry, Well Location
<br /> silty clay with concrete Address 508 West Charter Way
<br /> 6 11 Silt, light brown, loose to soft, moist,native soil. City StocktonSan Joaquin
<br /> 11 12 Sand with clay,dark brown, non plastic,firm, County
<br /> moist.
<br /> Latitude DeqMin. SecN Longitude _ W
<br /> . . Deo. Min. Sec,
<br /> 12 13 Silty clay, brown, non plastic,firm,dry to moist. Datum Decimal Lat. Decimal Long.
<br /> 13 16 Silty clay, light gray,non plastic,firm, dry to APN Book 165 Page 040 Parcel 16
<br /> moist. Township Ran a Section
<br /> Location SketchActivi
<br /> Sketch must be drawn by nand atter form is nnleo' ONew Well
<br /> North
<br /> 0 Modification/Repair
<br /> O Deepen
<br /> O Other
<br /> O Destroy
<br /> o...nces om�.d— m.,.na,
<br /> gym., En, we
<br /> Planned Uses
<br /> 0 Water Supply
<br /> ❑Domestic ❑Public
<br /> 3 w
<br /> []Irrigation ❑Industrial
<br /> O Cathodic Protection
<br /> O Dewatering
<br /> 0 Heat Exchange
<br /> 0 Injection
<br /> O Monitoring
<br /> O Remediation
<br /> O Spangling
<br /> South O Test Well
<br /> ewstm,.o,dou4n d� n, x—iifmm,o.daewama.,fee , 0 Vapor Extraction
<br /> -dmm.n.m.,.u...ddl—.i q.00,doo�....,r 0Other
<br /> PI....eb....u,.,..mcom mm.
<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 16 Feet Estimated Yield (GPM) Test Type
<br /> Total Depth of Completed Well 16 Feet Test Length (Hours) Total Drawdown
<br /> _(Feet)
<br /> 'Ma not be re resentative of a well's Ion term ield.
<br /> Cal Annular Material
<br /> Depth hBorehole Type Material Wall Outside Screen Slot size Depth from
<br /> Surfacee Diameter Thickness Diameter Type if Any Surface Fill Description
<br /> Feet to Feet Inches Inches Inches Inches Feet to Feet
<br /> 0 11 10 Blank PVC Sch.40 4 0 7 Cement
<br /> 11 16 10 Screen PVC Sch.40 4 0.020 7 10 Bentonite
<br /> 10 16 Filter Pack #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 Log(s) Person,Firm or corporation
<br /> 14110 Ca Ile Road Yolo CA 95695
<br /> ❑ Soil/Water Chemical Analyses Address oy state Zip
<br /> —
<br /> [Z] Other Site Map Sig 953646
<br /> Attach additional mtormaron e n exists. -5r tensed water well tom her
<br /> Date Signed C-57 License Number
<br /> DWR 188 REV.12006 I DITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM
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