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'The free Adobe Reader may be used to view and complete tfRARGrm. However,software must be purchased to complete,saverallE 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 Refer to rnsrruvion PamPhlar State Well Number/Site Number <br /> Owner's Well Number MW-7 No. e0180746 NW <br /> Date Work Began 06/10/2013 Date Work Ended 6/13/,2013 Rude <br /> _ Latitude Lon <br /> Local Permit Agency APNfrRslOther <br /> Permit Number Permit Date 5115113 <br /> Geologic Log. Well Owner <br /> Orientation OVertical 0Horizontal OAngle Specify Name City of Ripon <br /> Drilling Method Hollow Stem Au er Drilling Fluid none Mailing Address 259 N.Wilma Avenue <br /> Depth from Sulfate Description Ripon State C+4 Zi 95366 <br /> Feet tv Feet Describe material, rain size,color,etc Cit <br /> 0 50 Pressure Grout Well Location i <br /> Address City of Riaon ROW-Wil Ave.Arc Way,Frontage Rd) <br /> City Ripon -County County San Joaquin <br /> Latitude 37 746 532 N Longitude -121 131 1235p <br /> Dep, Min. Sec. Deci. Min, Sec. <br /> Datum Decimal Lat. Decimal Long. <br /> A15N Book Page Parcel ROW- <br /> Township <br /> OW_Townshi Range Section <br /> Location Sketch Activity <br /> iSketch must be drawn by hand atter form is nntad. New Well <br /> North O ModificationtRepair <br /> O Deepen <br /> O Other <br /> (j)Destroy <br /> �d>e peeetlures end materials <br /> untkr'GEOLOGrC LOG' <br /> Planned Uses <br /> Q Water Supply <br /> See Attached <br /> ]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 /> IIlvitrete a dnaibe distance of well ran weds,bV116-9a1 fenua, O Vapor Extraction <br /> rMt n,etc-and etach a map.Use addi'ricnal papa it necessary. O Other <br /> Please be xcunte and leu. <br /> titer Level and Yield of Completed Well. <br /> Dapth to first water (Feet below surface) <br /> Depth to Static <br /> Water Level (Feet) Date Measured <br /> Total Depth of Boring 50 Feet E:ilimated Yield' (GPM) Test Type <br /> Total Depth of Completed Well 50 Feet <br /> Test Length (Hours) Total Drawdown (Feet) <br /> 111ay not be representative of a well's long term yield. <br /> Casings. Annular Materiat. <br /> Depth from Borehole Wall Outside Screen Slot Size Depth from <br /> Type MaterialSurface Diameter Thickness Diameter Tirpe If Any Surface Fill Description <br /> Feet to Feet Inches Inches Inches Inches Feet to f=eet <br /> 0 45 18 Blank PVC Sch.40 2 1 141 1 Cement Portland Illi <br /> 45 50 18 screen PVC Sch.40 2 Milled Slots 0.020 41 43 Bentonite Pellets <br /> 43 50 Filter Pack #2112 <br /> Attachments.. Certification.5tatement <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 /> ❑Geophysical Log(s) 9245 Beatty.Drive Suite A S cramento CA 95826 <br /> © Sol]/Water Chemical Analyses Addr -r.� city state ry <br /> El Other Site Ma Signed_�_�'� 8/25/2013 848359 <br /> Attach additional IMortnaUon if It exists, <br /> -- C-57 Licensed Water Well CDritfactor Date Signed C-57 License Number j <br /> DWR 188 REV.1120M IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM i <br /> I <br />