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*The free Adobe Reader may be Used to view anr plete this form, However,software must be purchased to co <br /> File Criginal with DWFZ 11 save,and reuse a saved form. <br /> State Of California <br /> I.-.L)VVR I <br /> Page 1 of 'I Well Conipletion Report <br /> Referlo insituciiop pgmph;ej <br /> Owner's Well Number MW-3.7 No. e064005 <br /> State Well UeU,Me Number <br /> Date Work Began 10/29/2007 Date Work Ended 1 012 9120 07 N <br /> Local Permit Agency n Jo6_qbiIj C I Envir n�gntbl He Lon�,tde <br /> Permit Number 0049398 22ajy-�rn . aith 12Qr)2r[mqnt <br /> Permit Date 1/16/07 <br /> APNITRS10ther <br /> -7 <br /> Orientation OVertical C)H 0 <br /> Horizontal" Angle Specify Wel!-0 Wner"— <br /> Qril;ing Method Drilling Fluid Name Atlantic Richfield COrI <br /> Depth frorriS6, Mailing Address.6 Centerpoint Drive <br /> terial-,,-.'q rain'size '6616r,.etc CIt <br /> L43 Palma State-CA 71 <br /> Destro -4 b ressureOrr <br /> mushroom <br /> Location <br /> cat,at 3 feet below ground surface, <br /> Address <br /> -1617 West Fremont Street <br /> City Stockton County San Joaquin <br /> Latitude tv Longitude <br /> Dep. Min. sec.li, —W <br /> Doq. Min, Sec. <br /> Datum Decimal Lat <br /> ­..�.Declmal.Long. <br /> APIN Book 135 Page 11 Parcel 015= <br /> Township Ran e"" Section <br /> L oc Ai%r v­1fy-,A"L"-- <br /> at <br /> North (D New Welt <br /> ------ —7� ,O Modification/Repair <br /> 0 Deepen <br /> 0 Other_ <br /> (D Destroy <br /> Lj <br /> Describe ProcedUFes brtd materiels <br /> uQ.r'GE0I­031C Los- <br /> ..;=Plartinedalses -_ <br /> 0 Water Supply <br /> [-]Domestic OPublic <br /> Ejlrdgation Dindustrial <br /> 0 Cathodic Protection <br /> 0 Dewatering <br /> .0 Heat Exchange <br /> 0 Injection <br /> 0 Monitoring <br /> 0 Remediation <br /> 0 Sparging <br /> South 0 Test well <br /> Illustrate or eescrbe distance Orwell from roads,WII f.­Z� 0 Vapor Extractjon <br /> rivers,etc.and aftach a—P.Use additional paper 0 Other- <br /> Pleece 6e accurate and com tete. 7. <br /> at'er'Le'vel-andX-ieldbf C6rnpj6to'diw6lj <br /> Depth to first water (Feet below surface) <br /> Depth to Static <br /> Total Depth of Boring. Water Level (Feet) Date Measured <br /> Feet Estimated Yield (GPM) Test Type <br /> Total Depth of Completed well Feet Test Length (Hours) Total Drawdown (Feet) <br /> *May not be repr'esentative of a well's long term yield. <br /> =Annular-`:Material <br /> Depth from -'-Borehole <br /> wall Outside Screen Slot Size Depth from <br /> Surface Diameter Type Material <br /> Feet Fe Thickness Diameter Type if Any Surface Fill -Description <br /> Inches) (inches) }nclheS Feet to Feet <br /> 'Statennenf­-, <br /> :Attachments[ <br /> .-... <br /> 0 Geologic Log 1,the undersigned,certify that this report is complete and accurate to the best of my knowledge and belief <br /> 0 Well Construction Diagram Name Allan Dudding. Stratus Environmental. Inc. <br /> E3 Geophysical LoPerson,Farn-or Corporation.g(s) 3330 Cameron Park Dr. <br /> 0 Soil/Water Chemical Analyses Suite 550 Cameron Park CA 95682 <br /> Signed /qly� City State Zip <br /> ED Other Site Plan 9s(Q0 11/2/07 710079 <br /> lAtlechadditional information.ifi-,exists" C-57 Licensed water well Contractor <br /> :DWR 18B REV.112005 Date Signed C-57 License Number <br /> IF AEI SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />