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QUADRUPLICATE STATE OF CALIFORNIA DWR USE ONLY — DO NOT FILL IN <br /> For Lac Requirements WELL COMPLETION REPORT _ <br /> Pe,gel if I Rep, to Inslrucrimr Ranrphlel STATE WELLNO.ISTATION No. <br /> Owner's Well No 2 No. 739632 1❑ <br /> Date Work Began 0122/01 Ended0123/01 _.._ LATITUDE .LONGITUDE <br /> Local pcmlit Agency San Jnanuin Cn FHT) LL__i_-, I I I I I 11 <br /> Permit No. 25096 Permit Date 0122/01 APNITRSIOTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(v) VERTICAL _HORIZONTAL — ANGLE —(SPECIFY) Nvane Abelardo Montes _ <br /> DRILLING ROTARY <br /> DEPTH FROM METHOD FLUID MUD Mailing Address 11545 W Valpieo Rd <br /> DESCRIPTION _Tracy —_ .___ CA95376 <br /> Ft. m FL Demribe meler/aI. grain. tre, cnyar, etc. CITY STATE ZIP <br /> 0; 20:topsoiVrock/gravel 1 WEU. LOCATION <br /> 20: 35:clayAddress 1545 W ValDico Fie <br /> 35 46:sand/small City Tracy CA 95376 <br /> gravel/rock County SAN JOAQUIN <br /> 46; 49;clay <br /> 49: 72;sand/graveVroek APN Book 242_Page 050 parcel 13 _ <br /> 72: 83:clay Township --Range Section <br /> i,atitudc i I <br /> 83: 90:gravelfrock DEG. MIN. SEC. DEG MMI. SEC <br /> 90: 91 :clay LOCATION SKETCH--ACTIVITY (✓) <br /> 91 :—97:gravel/rock NORTH — _✓ NEW WELL <br /> 97 104:clay MODIFK ApR^PAIR <br /> 104: 113:gravelfrock —ome.ISpeeily) <br /> 113:13:1191 clay _ <br /> — DESTROY(Dascdbe <br /> 119; 125;gravel/rock Procedmea aM Materials <br /> Under"GEOLOGIC LOG' <br /> 125 142:clay 4PLANNED USES 00 <br /> 142; 144:gravelfrock WATER SUPPLY <br /> 144: 154:Clay 1— --RK Put <br /> __ us al <br /> Img,man — <br /> 154: 155;gravel 3 <br /> MONITORING— <br /> 155: 164:Clay ravel TEST WELL— <br /> 164: 181 : <br /> 9 — ATHODIC PROTECTION— <br /> 181 : 185 clay HEAT EXCHANGE- <br /> 185: 188:gravel DIRECT PUSH- <br /> 188: 200:Clay INJECTION_ <br /> VAPOR EXTRACTION — <br /> SPARGING_ <br /> SOUTH REMEDIATION— <br /> I/Ws/rais 9s DucNbs Dislurar o/Wd/fr m Rmnb, Buildings, <br /> Fetes,Rivera,etc and allach a map. Use additional paper if OTHER(SPECIFY)- <br /> ---- naeexsarv.PLEASE RE ACCURATE. A COMPLETE. <br /> WATER LEVEL& YIELD OF COMPLETED WELL <br /> DEPTH TO FIRST WATER 58 (FL)BELOW SURFACE 1 <br /> DEPTH OF STA <br /> WATER LEVEL o4 (FL)&DATE MEASURED 0124/O1 <br /> TOTAL DEPTH OF BORING 200ESTIMATED YIELD ' (GPM)8 TEST TYPE <br /> 200VOA) TEST LENGTH_(His.) TOTAL DRAWDOWN (Ft) <br /> TOTAL DEPTH OF COMPLETED WELL 183 (Feet) Mo nur he rc resemative n'a well(a Inn -lean �ieW. <br /> DEPTH CASING (S) ANNULAR MATERIAL <br /> FROM SURFACBORE- DEPTH <br /> E HOE TYPE FROM SURFACE TYPE <br /> CIA. z � a- MATERIAL/ INTERNAL GAUGE SLOT SIZE CE BEN- <br /> Ft. to Ft finches) g m , n GRADE DIAMETER OR WALL IF ANY MENT TON FILL FILTER PACK <br /> m O -i (Inches) THICKNESS (Inches) Fc W Ft pYPE/SIZE) <br /> 0; 163 12 PI ASTIC 6 — o too <br /> 163: 183 12 ✓ 1 6x12 <br /> ATTACHMENTS (Z,) CERTIFICATION STATEMENT <br /> Geologic Log I,the undersigned,cedify Nal tin repeal is complete arm accurate b me best of my knowledge and lieliel. <br /> Well Conshucibn Diagram NAME CALWATER DRILLING F INC. <br /> Geophysmal Log(s) (PERSON,FIRM,OR CORPORATION) (TYPED OR PRINTED) <br /> — SthllWater Chemical Analysis 300 S. KJlrovRd. Turlock CA <br /> _— Other ADDRE CRY STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION,/F/T,-XMTS Sprrod — --_----- -1_.__--- 434Z1e—.----- <br /> W L D ILLER/A HORIZED REPRESENTATIVE DATE SIGNED G57 LICENSE NUMBER <br /> DwR laa RI:V.1 .9t IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />