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I <br /> 'The free Adobe Reader may be used to view and complete PIlorm. However,software must be purchased to complete,save reuse a saved form. <br /> m <br /> File Original with DWR State of Califomia DWR Use Only=Do Not F€II In <br /> Well Completion Report <br /> Page 1 of 1 Refer to Insrrucrron Pam011W State Well NumberrSite Number <br /> Owner's Well Number MW-9 NO. e0180748 E1:1= IN w <br /> Date Work Began 06/10/2013 Date Work Ended 6113/2013 _ Latitude Longitude <br /> Local Permit Agency APNffRSlOI <br /> 67 <br /> Permit Number 00169 _ Permit Date 5115113 <br /> ther <br /> Geologic Loa Well Owner. <br /> orientation OVertical 0HorizontaI 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 Ri on State CA Zi 95366 <br /> .Feet .to feet Describe material; rain size,color,etc Cit <br /> 0 30 Pressure Grout Well Location <br /> Address Cily of Ripon ROW Mil eo Ave Arc.Way.Fronto a Rd <br /> City Ripon County San Joaquin <br /> Latitude 37 746 532 N Longitude -121 131 1235w <br /> Deo. Min. Sec. D". Min. sec. <br /> Dictum Decimal Lat. Decimal Long. <br /> APN Book Page Parcel ROW <br /> Townshi Ran a Section <br /> Location Sketch Activi <br /> 'Sketch must be drawn by hated after form isprinted) 0 New Well <br /> North 0 Modification/Repair <br /> O Deepen <br /> O Other <br /> 0 Destroy <br /> DesatD procedwes rad materlab i <br /> und.'GEOLOGIC LOG' <br /> Planned Uses <br /> 0 Water Supply <br /> See Attached []Domestic ❑Public <br /> ^t, w ❑Irrigation ❑Industrial <br /> 0 Cathodic Protection <br /> 0 Dewatering <br /> Heat Exchange <br /> 0 injection <br /> 0 Monitoring <br /> 0 Remediation <br /> Q Sparging <br /> South 0 Test Well <br /> 0 Vapor Extraction <br /> IFw rtrMa.deapi6r tlfelance of wetl fiom roads.pulldinps,tertoee, <br /> fly—, M.end attache map.uae odd bwal pap.4t neceasery. 0 Other <br /> pw ere be accurate rntl tom lets. <br /> Vilater Level and Yield of Com leted Well <br /> Depth to first water (Feet below surface) <br /> Depth to Static <br /> Water Level (Feet) Date Measured <br /> Total Depth of Boring 30 Feet Estimated Yield' (GPM) Test Type <br /> Tnl Length (Hours) Total Drawdown (Feet) <br /> Total Depth pt Completed Well 30 Feet LtAay not be re resentative of a well's long term yield. <br /> ina <br /> ss Anntalar,Material <br /> Type Casings. <br /> Material sin <br /> Depth from BoreholeWall Outside Screen Slot Size Depth from <br /> Surface Diameter Thickness Diameter T;/pe If Any Surface Fill Description <br /> Feet to Feet Inches Inches Inches Inches Feet to Feet <br /> 0 15 8 Blank PVC Sch,40 2 1 112 1 Cement Portland 1111 <br /> 15 30 18 Screen IPVCSch.40 2 Millec Slots 0.020 12 113 113entonite Chips <br /> 13 130 Filter Pack #3 <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 /> 0 Well Construction Diagram Name All Well Abandonment, Inc. i <br /> Person.Firm or Corporation I <br /> ❑ Geophysical Log(s) 9245 Beatty Drive Suit � ""� Cramento CA 95826 <br /> ❑ Soil/Water Chemical Analyses Addy �' city State zip <br /> Signed _—' " -"'� 6/25/2013 848359 <br /> ❑� Other Si Ma alled-wai-roletirontractor Date Signed C-57 License Number <br /> Attach additional Inrorm tion If It exists <br /> OWR 188 REV,112006 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />