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I <br /> 'The free Adobe deader may be used to view and complete W... 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 I;I-I I <br /> Page 1 of 1 Refer Jo instruction Pamphlet State Well Number/Site Number <br /> Owner's Well Number OSP3A No. e0180780 F—T—F—i--�� ._1_ I I = <br /> Date Work Began 06/10/2013 Date Work Ended 611311'2013, _ Latitude Longitude <br /> Local Permit Agency <br /> Permit Number Permit Date 5115113 APN1TRSlOther <br /> Geologic LoWell Owner <br /> Orientation OVertical 0Horizontal OAngle Specify Name Lee Shocky _ <br /> Drilling Method Hollow Stem Auger Drilling Fluid none Mailing Address 205 Pedras Road <br /> Depth from Surface Description Turlock CA 95380 <br /> feet to Feet Describe material,.: rain size,color,etc CF; State�i <br /> 0 40 Pressure Grout Well Location <br /> Address 8 Mil eo 6venue <br /> Ctly Ripon County San Joaquin <br /> Latitude 37 746 269 N Longitude -121 131 65 w <br /> pea. Min, Sec. Deq. Min. Sec. <br /> Datum Decimal Lat. Decimal,Long, <br /> AVN Book 261 Page 050 Parcel 01 <br /> Township Ran e. Section <br /> Location Sketch ActlVl <br /> (Sketch must be drawn by hand after form is.printed.) O New Well <br /> North O Modification/Repair <br /> O Deepen <br /> O Other <br /> Q Destroy <br /> Ueec�e pfOCEeulea arW malenara <br /> untler'OEOL�I-LOG <br /> Planned Uses <br /> O Water Supply <br /> See Attached []Domestic ❑Public <br /> w ❑irrigation [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 /> O Vapor Extraction <br /> Nusaate or tlesaibe distamemAP.or mail from rands,GueGrtee.fenMnecessary. <br /> O Othei <br /> lir..,etc.and attach a map.U�Se sEtliflanal paper if neceaeary. <br /> Piro.W accurate antl c t!- <br /> Water Level and Yield of Completed Well <br /> Depth to first water (Feet below surface) <br /> Depth to Static <br /> Water Level _(Feet) Date Measured <br /> Tota!Depth of Boring 40 Feet Estimated Yield' (GPM) Test Type <br /> Test Length (Hours) Total Drawdown (Feet) <br /> Total Depth of Completed Well 40 Feet *lAay not be re resentative of a well's long term yield. <br /> Casln s Annular Material -- <br /> Depth from Borehole Wall Outside Screen Slot Size Depth from <br /> Type Material Thickness Diameter type If Any Surface Fill Description <br /> l <br /> Surface Diameter Inches Inches Inches Feet to Feet <br /> Feet to Feet Inches 314 1 35 Cement Portland 1111 j <br /> 0 37 8 Blank PVC Sch.4t7 <br /> 37 40 $ Screen PVC Sch.40 314 Mesh Diffuse 35 36 Bentonite Pellets <br /> 36 40 Filter Pack X2112 <br /> Attachments certification Statement <br /> ❑ Geologic Log 1,the undersigned,certify that this report is complete and accurate to the best of my knowledge and belief <br /> [:1 Well Construction Diagram Name All Well Abandonment Inc. <br /> Parson,Firm or Corporation rtto CA 95826 <br /> ❑Geophysical Log(s) 9245 Beattyive DrSuite A <br /> Adores City state zp <br /> ❑ SoillWater Chemical AnalysesSigned 6/25/2013 848359 <br /> ❑ Other Site Map al en Contractor Date Signed C-57 License Number <br /> Attach additional Information if it exists. <br /> DWR 188 REV 1f2006 IF ADDITIONAL SPACE IS NEEDED.USE IJEXT CONSECUTIVELY NUMBERED FORM <br />