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ORIGINAL STITF OF C\LIFUI{\Ia DWR USE ONLY — DO NOT FILL IN <br /> File with i WELL COMPLETION REPORT F I I I I I I I <br /> P.WL of 1 hirci to IrilrlllLooll Pamphlot STATE WELL NO'STATICN NO <br /> ovinei �A mil No MW7 No L �J I I I I <br /> LATITUDE LONGITUDE <br /> I� ltel\l)11. 13e�)n — — Ctxled — — <br /> Ll1C it PL1itt[t '10i026,236 <br /> 1tiC;11(,\G San - '..�` <br /> Yr l Illlt \t1 0 0 2 6 2 VC. Pe]alit late C;_1 _03APNITRSIOTHER <br /> GEOLOGIC LOG NVELL OWNER <br /> EEE�Hou <br /> `dERTICAL —HORIZONTAL —ANGLE —(SPECIFY) Ndt11C Exxnn Mnh 1 l Oil Cnrnn r-a h:1 an <br /> DRILLING Muhna -Wdiess 2300 Clayton M. ste 1250 <br /> DEPTH FROM FLUID Concord CA 94520 <br /> SURFACE DESCRIPTION r <br /> Ft to Et Dc sc i lbr niulr r ial ,r rterl stTc Loloi etc CITY STATE ZIP <br /> / ( <br /> S. El Dora Ida L� ree t <br /> �dd1 ess <br /> G,t Stockton <br /> Couilty San joacruin <br /> 1PN Book Page L P ticel <br /> T'oivii%hip Range Section <br /> ' Latittide I I NORTH LOiiptude I I WEST <br /> DEG MIN SEC DEG MIN SEC <br /> LOCATION SKETCH A.CTINITY (t) <br /> ' NORTH _ NEW WELL <br /> See attached site plan. MODIFICATIONIREPA;R <br /> Deepen <br /> Other(Specify) <br /> __._ DESTROY(Describe <br /> Procedures and Materials <br /> ' Under GEOLOGIC LOG ) <br /> PLAN\TED USES (t) <br /> I k WATER SUPPLY <br /> Domestic Public <br /> F krrii Industrial <br /> m <br /> ' W 4 MONITORING <br /> � w <br /> I <br /> TEST WELL <br /> I r CATHODIC PROTECTION _ <br /> HEAT EXCHANGE <br /> i DIRECT PUSH <br /> INJECTION <br /> VAPOR EXTRACTION <br /> SPARGING <br /> I I SOUTH REMEDIATION <br /> Ilhrstlat( ou Derrnln Dttaricc of 11<11 lmrrt Rands Bluidma% <br /> i Ptlrces RICLIS etc gild attach a rrlujri Mise afirdil onnl Jfaller if OTHER(SPECIFY) <br /> Irl.cc ssarlr PLEASE BE �lCCURrtTE C011FL.LTL: <br /> I r <br /> ` ITER LEVEL Sr YIELD OF COMPLETED IVELL <br /> j DEPTH TO FIRST WATER (Ft) BELOW SURFACE <br /> DEPTH OF STATIC <br /> WATER LEVEL (Ft)&DATE MEASURED <br /> ESTIMATED YIELD (GPM) & TEST TYPE <br /> 101 1L DEIMI OF 130111\C 1«t1 TEST LENGTH (Hrs) TOTAL DRAWDOWN (Ft J <br /> ft)Tll IDEP71I OF C0\11'I CTrD 11 ELL ____A(e_(2_(F�et) . holy liar be repicsentratraL of a -ells long-tend luld <br /> DEPTH BORE CASING (S) DEPTH AN\ULAR MATERI kI, <br /> FROM SURFACE <br /> HALE TYPE(-. ) FROM SURFACE TYPE <br /> DIA x w a MATERIAL I INTERNAL GAUGE SLOT SIZE CE BEN <br /> (Inched J zoo a GRADE <br /> DIAMETER OR WALL €F ANY MENT TONITE FILL FILTER PACK <br /> Ft to Fi m ctq (Inches) THICKNESS (Inches) FI to Ft ( � ) (�) ( � ) (TYPElSZE) <br /> 3k, <br /> Ht� lata UCS Z �, "c: ?c <br /> 3F tt' - x zt <br /> I , <br /> I , <br /> 1TT1C1I11ENfS f } CL'RTIFICMON STATE\ILNT <br /> Geologic Log <br /> I the underslgn$d certify that this report is Complete and accurate to the best of my knowledge and belief <br /> 9 L} L Lc, '-4 (- 1i .. nck <br /> Well Construction Diagram NAME i 11J�— <br /> (PERSDN HRRM CR CORPORATlDN) !TYPED OR PRINTED) <br /> _ Geophysical Log(sl J _ <br /> r SoillWater Clemical Analyses <br /> A- 1 L24 <br /> 1 `� S Y ADDRESS I.ITY STATE ZIP <br /> _ Oilier ��� <br /> A17AL-i ADDITIONAL INFORMATION IF,T EXISTS Signed -''»1t, ! /�L'�--• I � L' <br /> �RrAUTHDRlZE�REP ATIVf DAT 51GNED C tl7 LICENSE NUMBER <br /> Iris! rtiti 1 [t 11 i IF ADDITICPIAL SPbCE IS NEEDED USE NE`- CONSECUTIVELY NUMBERED FORM <br />