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TRIPLICATE STATE OF CALIFORNIA DWR USE ONLY — DO NOT FILL IN <br /> Owner's Copy WELL COMPLETION REPORT iiliilillill <br /> Page 2 of 3 Refer to Instruction Pamphlet STATE WELL NO./STATION NO. <br /> Owner's Well No. No. 5 2 0 7 5 8 0 <br /> 11- — 11-14-97 LATITUDE LONGITUDE <br /> Date Work Began Ended <br /> Local Permit Agenc San Joaquin County <br /> Permit No. 14090 Permit Date 10-30-97 APN/TRS/OTH R <br /> GEOLOGIC LOG ` ..WELL OWNER <br /> ORIENTATION _VERTICAL _HORIZONTAL _ANGLE _(SPECIFY) Name,Ralph ' P.Qm6b\ <br /> DEPTH TO FIRST WATER (FL) BELOW SURFACE Mailing Address <br /> DEPTH FROM <br /> SURFACE DESCRIPTION <br /> ',, <br /> Ft. to Ft. Describe material,grain size,color,etc. - STATE ZIPW EL C A T I 0 N <br /> 289 312 claysandy Address ea soutO racy lvd . <br /> 312 ' 317 sand & gravel City <br /> 317 337 gravel good - <br /> County <br /> 337 343 cls APN Book Page Parcel <br /> 343 ' 354 grav81 Township Range Section <br /> 354 356 clay or <br /> Latitude NORTTI <br /> 356 375 sand .& ravel. Longitude WEST <br /> DEG. MIN. SEC. DEG. MIN. SEC. <br /> r LOCATION SKETCH ACTIVITY (�) <br /> 375 385 ravel -NORTH <br /> — NEW WELL <br /> 385 388 clay <br /> j MODIFICATION/REPAIR <br /> 388 ; 394 ; ravel —Deepen <br /> 394 396 sandy clay —Other(Specify) <br /> 396 ' 404 ' gravel <br /> 404 405 clay <br /> 405 ; 409 i ravel DESTROY(Describe <br /> Procedures and Materiels <br /> Under"GEOLOGIC LOG') <br /> 409 415 sandy clay PLANNED USE(S) <br /> 415 ' 425 gravel < (-) <br /> W MONITORING <br /> 425 ; 432 i clay WATER SUPPLY <br /> 432 436 sand & ravel <br /> 436 ' 438 ' clay <br /> Domestic <br /> p Public <br /> 438 ; 444 ; sand & ravel _ Irrigation <br /> 444 ; 446 clay <br /> p Industrial <br /> 446 ' 448 ' sand & gravel ..TEST WELL'. <br /> 448 450 ' sand clay _ <br /> ODIC PROTEC- <br /> 450 ; 453 sand & gravel SOUTH TIONIllustrate or Describe Distance of Well from Landmarks — OTHER(Specify) <br /> 453 462 sand clay such as Roads,Buildings,Fences,Rivers,eta. <br /> 462 469 sand & caval <br /> PLEASE BE ACCURATE v COMPLETE. <br /> ' ' <br /> 469 471 sandy clay DRILLING <br /> FI UID <br /> 471 485 sand & ravel METHOD�ATER LEVEL & YIELD OF COMPLETED WELL <br /> 485 488 ' clay DEPTH OF STATIC <br /> WATER LEVEL (Ft.) & DATE MEASURED <br /> 488 491 ' sand & ravel ESTIMATED YIELD" (GPM) & TEST TYPE <br /> TOTAL DEPTH OF BORING (Feet) TEST LENGTH (Hrs.) TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL (Feet) "May not be representative of a well's long-term yield. <br /> DEPTH CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE BORE- <br /> '� HOLE TYPE _ FROM SURFACE TYPE <br /> INTERNAL GAUGE SLOT SIZE <br /> (InDches) a o� s MGRA EL/ DIAMETER OR WALL IF ANY CE- BEN- FILTER PACK <br /> Ft. to Ft. m v » (Inches) THICKNESS <br /> (Inches) Ft. to Ft- MENT TONITE FILL (TYPE/SIZE) <br /> ATTACHMENTS CERTIFICATION STATEMENT <br /> Geologic Lop I,the undersigned,certify that this report is complete and accurate to the best of my knowledge and belief. <br /> — Well Construction Diagram NAME <br /> — Geophysical Log(s) (PERSON, FIRM, OR CORPORATION) (TYPED OR PRINTED) <br /> ... — Soil/Water Chemical Analyses - <br /> Other ADDRESS CITY STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION. IF IT EXISTS. Signed <br /> WELL DRILLER AUTHORIZED REPRESENTATIVE DATE SIGNED C-57 LICENSE NUMBER <br /> DWR188REV.7-90 IF ADDITIONAL SPACE IS NEEDED, USE NEXT CONSECU YIVELY NUMBERED FORM <br />