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'The frJ6 Adobe Reader may be used to view and complis torn. However,software must be purchased to complete. and reuse a saved form <br /> ADV <br /> \1R Original with DR State of California DWR Use onl -Do Not Fin In <br /> Page 1 of , Well Completion Report <br /> Referm Insxmo'ion vamphkt State Well Number/Site Number <br /> Owners Well Number MW-02 No. e0196053 <br /> Date Work Began 05/16/2013 Date Work Ended 5/16/2013 Latitude l.o nude <br /> Local Permit Agency San Joaauin County Environmental Health I <br /> Permit Number Permit Date 4/16/13 APN/TRS/Other <br /> Geologic Log Well Owner <br /> Orientation OVertical 0Horizontal OAngle Specify Name PG&E <br /> Drilling Method Hollow Stem Auger Drilling Fl.,d Mailing Address 3400 Crow Canyon Road <br /> Depth from Surface Description <br /> Feet to Feet Describe material, rain size,color,etc Ci San Ramon State_CA___Zip 94583 <br /> 0 3 Sand <br /> 3 4 Clay Address 1181 Zuckerman Road <br /> 3.5 16 Sand City McDonald Island, Tracy County San Joaquin <br /> Latitude N Longitude <br /> Deo. Min. Sec. Dec Min Se,,. <br /> Datum NAD83 Dec. Lat. 37.989268 Dec. Long. 121.480399 <br /> APN Book Page Parcel 129-310-12 <br /> Township -Range Section <br /> Locatlon;.51oBteh Activit <br /> Sketch must.bedrawn.p ihaod_after tons trial Q New Well <br /> Nbo Q Modification/Repair <br /> O Deepen <br /> O Other <br /> O Destroy <br /> QLOGi,..."d <br /> lfaJ.f'-fJ' Planned Uses <br /> O Water Supply <br /> ❑Domestic ❑Public <br /> 3 to ❑Irrigation ❑Industrial <br /> O Cathodic Protection <br /> O Dewatering <br /> O Heat Exchange <br /> O Injection <br /> 0 Monitoring <br /> O Remediation <br /> O Spangling <br /> South O Test Well <br /> Vapor Extraction <br /> .oe adecn.map.U...dd.o c O nm,er <br /> vb...e.. u=md co wit. <br /> f"Completed Well <br /> Depth to first water (Feet be lcm surface <br /> Depth to Static <br /> Water Level (Feet) Date Measured <br /> Total Depth of Bonng 16 Feet Estimated Yield" (GPM) Test Type <br /> Total Depth of Completed Well Feet Test Length (Hours) Total Drawdown (Feet) <br /> `Ma not be re resentative of a well's long term yield. <br /> Casin s:x '`g <br /> Depth from Borehole T Wall Outside Seven Slot Size Depth from <br /> Surface Diameter Type Material Thickness Diameter Surface <br /> Fast to Feet Inches Inches Inched TypeIf <br /> Feet Fill Description <br /> Feet <br /> 0 6 161. 1 Blank JPVc Sch.40 0 11 1 Well Box <br /> 6 16 8" Screen PVC Sch.40 Mined Slots 0.010 1 5 Cement Neat Cement <br /> 5 5 Bentonite Hydrated Chips <br /> 5 16 Fill 2/12 Monterey Salts <br /> ,, ..` ttachma7fts s <br /> gpeologic Log I,the undersigned,certlfy that this report Is complete and accurate to the best of my knowledge and belief <br /> Well Construction Diagram Name Woodward DNllina Comoanv. Inc. <br /> ❑ Geophysical Log(s) 550 Rivererson,Flrmarcurpcisticn Road RIO Vista CA 94571 <br /> 17 SoilNvarer Chemical Analyses addmsC.1 state Zip <br /> IOther, Signed &hd&ff1X1/2/2013 710079 <br /> Attract additional information it it eusts. C­57 Licarseor watrIverCorltreclor Date Sinned C-57 License Number <br /> CAR 18B REV.1/2008 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />