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The free Adobe Reader may be used to view and comp his form. However,software must be purchased to complete, and reuse a saved form <br /> File C`ninal vdt''I DWR State of California DWR Use Only-Do Not Fill In <br /> Well Completion Report <br /> Page 1 of 1 Refer to Instruction Pamphlet <br /> Owner's Well Number MW-03 No. e0196055 State Well Number/Site Number <br /> I 7N <br /> Date Work Began 05/16/2013 Date Work Ended 5/16/2013 Latitude Lo Rede <br /> Local Permit Agency San Joaquin County Environmental Health <br /> Permit Number Permit Date 4/16/13 APN/TRS/Other <br /> Geologic Log Well Owner <br /> Orientation OVertical 0Horizontal OAngle Specil Name PG&E <br /> Drilling Method Hollow Stem Auger Drilling Fluid <br /> Depth from Surface Description Mailing Address 3400 Crow Canyon Road <br /> Feet to Feet Describe material,chain size.color,etc City San Ramon State CA �I 54583 <br /> 0 Sand W611 Location <br /> Address 1181 Zuckerman Road <br /> City McDonald Island, Tracy County San Joaquin <br /> - - Latitude N Longitude <br /> Deal Min. Sac. Deal Min. Sec. <br /> Datum NAD83 Dec.Lat, 37.989425 Dec.Long. 121.480712 <br /> APN Book Page Parcel 129-310-12 <br /> Township —Range Section <br /> I� Locations Sketch Activit <br /> Setah musics drawn ItKana after rom is prirted New Well <br /> North O Modification/Repair <br /> O Deepen <br /> O Other <br /> O Destroy <br /> _, ceow=ic <br /> Planned Uses <br /> O Water Supply <br /> ❑Domestic ❑Public <br /> 3 DLK t-l�.l_C�C-leu w ❑Irrigation ❑Intlustrial <br /> 0 Cathodic ProtectionRECEIVED 0Dewatering <br /> O Heat Exchange <br /> JAN 14 2014 O Monitor ng <br /> O Remediation <br /> ENVIRONMENTAL HEALThi O Sparging <br /> PER Ir0 Test Well <br /> ulueo-.0 cr doeodl,e asence ofeed fromoed..bLid,onsfO Vapor Extraction <br /> 'W—,mc.end ins�a n,ap,U.'"1 pe,.,„e......,. O Other <br /> I PNua beeccurab xq Mb. <br /> ilifrCompleted Vilellf <br /> Depth to first water (Feet below surfacei <br /> Depth to Static <br /> Water Level (Feet) Date Measured <br /> Total Depth of Boring 17 Feet Estimated Yield' (GPM) Test Type <br /> Total Depth of Completed Well 15 Feel Test Length (Hours) Total Drawdown (Feet) <br /> *May not be representative of a well's long term yield. <br /> Casings - Annular Material <br /> Depth from Borehole Type Material Wall Outside Screen Slot Size Depth from <br /> Surface Diameter yP Thickness Diameter Type if Any Surface Fill Description <br /> Feet to Feet Inches Inches Inches Inches Feet to Feet <br /> 0 6 8. Blank PVC Sch.4b 0 1 Well Box <br /> 6 16 8" Screen PVC Sch.40 Milled Slots 0.010 1 5 Cement Neat Cement <br /> 5 5 Bentonite Hydrated Chips <br /> 5 17 Fill 2/12 Monterey Sere <br /> Attachments <br /> Geologic Log I,the undersigned,certify that this report is complete and accurate to the best of my knowledge and belief <br /> r Well Construction Diagram Name Woodward Drillino Comoanv. Inc. <br /> ❑ Geophysical LD S) Person,Firm or corporation <br /> 9( 5 0 Riv r Rod Rio Vista CA 94571 <br /> ❑ Soil/Water Chemical Analyses Address city state Zip <br /> 7 Other Signed CQ7(r�(,�'ur !"[�Daj�IM�t-� 1/2/2013 710079 <br /> Attach additional trttormal if It ewers. CST licensed WV well Contractor Date Signed C-57 License Number <br /> DM 188 REV.12006 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />