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'The free Adobe Reader maybe used to view and complete term. However,software must be purchased to complete,save reuse a saved form, <br /> File Original with DWR State of California DWR Use Only-Do Not Fill In <br /> Well Completion Report <br /> Page 1 Of 1 Rater to Mslraction Pamphrttr State Well Number/Site Number <br /> Owner's Well Number MW-6 No. e0180745 I I I NT-I—T-T7[wfl <br /> Date Work Began 06!1012013 Date Work Ended 6/13!2013 _ LatitudeLon nude <br /> Local Permit Agency <br /> Penna Number 0067169 Permit Date 5115113 APNFTRS/Other <br /> Geologic Log, 'Well Owner <br /> Orientation OVertical 0Horizontal OAngle Specify Name City of Ripon <br /> Drilling Method Hollow Stem Auger Drilling Fluid none Mailing Address 259 N.Wilma Avenue <br /> Depth from Surface Description Ripon CA 95366 <br /> Feet to Feet Describe material rain size,color,etc Cit pon State l2i <br /> 0 50 Overdrill Well Location <br /> Address City of Ria OW(Milaeo Ave,Arc Way.Frontme-RdL <br /> City Ripon County San Joaquin <br /> Latitude 37 746 532 N Longitude -121 131 1235 W <br /> Dea. Mtn. Sec, Dee Min. Sec. <br /> Datum Decimal Lat. Decimal Long. <br /> AI'N Book Page Parcel ROW <br /> Township Range Section <br /> Location Sketch Activi <br /> Sketch must be drawn b hand after form is tinted. O New Well <br /> North O ModificationlRepalr <br /> Q Deepen <br /> O Other <br /> O Destroy <br /> Describe procedures and material <br /> under'GEOLDGID LOG' <br /> Planned Uses <br /> Q Water Supply <br /> El Domestic ❑Public <br /> See Attached w OIrrigation ❑industrial <br /> O Cathodic Protection <br /> O Dewatering <br /> O Heat Exchange <br /> O Injection <br /> O Monitoring <br /> O Remediation <br /> O Sparging <br /> South O Test Well <br /> nMaoate ct describe distance Owed Yom raads,buildlnps.fencaa, O Vapor Extraction <br /> Nem.etc.and stich a map.'use additional paper i1"canary. O Other <br /> Pkase be aeeuMa and a km. <br /> Water Level and Yield of Completed Well <br /> Depth to first water (Feet below surface) <br /> D-pth to Static <br /> Water Level (Feet) Date Measured <br /> Total Depth of Boring 50 Feet Estimated Yield' (GPM) Test Type <br /> Total Depth of Completed WeII 50 Feet Tt;st Length (Hours) Total Drawdown (Feet) <br /> UlMay not be representative of a well's long term yield. <br /> Casings.- Annular Material._ <br /> Depth from 9orehote WeII Outside Screen Slot Size Depth from <br /> Surface Diameter Type Material Thickness Diameter T±rpe If Any Surface Fill Description <br /> Feet to Feet inches Inches inches (inches), Feet to Feet <br /> 0 45 8 Blank Pvc Sch.40 2 1 41 Cement Portland I!I <br /> 45 50 8 Screen PVC Sch.40 2 Milled Slots 0.020 41 43 Bentonite Pellets <br /> 43 50 Filter Pack #2112 <br /> Attachments_ Certification Statement <br /> ❑ Geologic Log I,the undersigned,certify that this report is complete and accurate to the best of my knowledge and belief <br /> ©Well Construction Diagram Name All Well Abandonment Inc. <br /> Person,Firm or Corporation <br /> 0 Geophysical Log(s) 9245 Beatt Drive Suite Sacramento CA 95826 <br /> ❑Soil/Water Chemical Analyses qua City._-- Cay State zip <br /> ❑� Other Site Ma Signed �r� =RM r T 6/25/2013 848359 <br /> Attach additional information If k amdsts. <br /> c used water WeII ContractorDate Signed C-57 License Number <br /> DVVR 188 REV.1WN IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />