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ORIGINAL STATE OF CALIFORNIAwR USE ONLY — 00 NOT FILL I <br /> File with DWR WELL COMPLETION REPORT <br /> Page 1 of 1 Refer to Instruction Pamphlet STATE WELL NOdSTATION NO. <br /> Owners Well No.-MW-1 No. e027932 �� 0 <br /> Date Work Began 7/19105 Ended 7/19/05 LATITUDE LONGITUDE <br /> Local Permit Agency San Joaquin County Uepartment of Environmental Health <br /> • Permit No. UU42542 Permit Date 6/1/U5 APNITRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION (t) Y( VERTICAL -HORIZONTAL -ANGLE -(SPECIFY) Name Chevron Environmental Mgnoement <br /> i�OD FLUID Mailing Address F'O pox 60]1. <br /> DEPTH FROM <br /> DESCRIPTION San Ramon:CA 94583 <br /> FL to Ft Describe material, grain sine, color, etC. CA STATE ZIP <br /> WELL LOCATION <br /> Address 25651 North Highway 99 <br /> 0 r 83 i Portland 1/II Cement L'iry Aramoo' <br /> r I <br /> County San Jeapuin <br /> ' APN Book 005 Page 141 Parcel 20 <br /> ' Township. Range Section <br /> ' Latitude I NORTH Longitude WEST <br /> DEG. MIN. SEC. DEG. MIN. SEC. <br /> LOCATION SKETCH ACTIVITY (�) <br /> I NORTH <br /> _ NEW WELL <br /> MODIFICATIOWREPAIR <br /> _ Deepen <br /> Other(Specify) <br /> r t <br /> DESTROY(Deeptbe <br /> PiOpdwes and Malod" <br /> Under"GEOLOGIC LOG-7 <br /> PLANNED USES <br /> WATER SUPPLY <br /> _ Dons" Public <br /> r 1 <br /> Iniptlion Industrial <br /> N <br /> 3 � MtxilroRuaG_ <br /> I r TEST WELL <br /> r CATHODIC PROTECTION_ <br /> HEAT EXCHANGE <br /> DIRECT PUSH <br /> INJECTION <br /> VAPOR EXTRACTION_ <br /> r r SPARGRJG_ <br /> r r <br /> STH REMEDIATION_ <br /> Illustrate or Dacrfbs Diatnnce of WeA froni Roods,Buildings <br /> Fences,Riven,etc.and attach nu rtddiPLE r f <br /> OTHER(SPECIFY) <br /> necesaanj.PLEASE BE ACCURATE G COHPIETE. <br /> r r <br /> WATER LEVEL & YIELD OF COMPLETED WELL <br /> DEPTH TO FIRST WATER (FL)BELOW SURFACE <br /> DEPTH OF STATIC <br /> WATER LEVEL (Ft)d DATE MEASURED <br /> r r <br /> ESTIMATED YIELD` (GPM)8 TEST TYPF <br /> TOTAL DEPTH OF BORING 83 (Feet) TEST LENGTH (Hrs.)TOTAL DRAWDOWN (FL) <br /> TOTAL DEPTH OF COMPLETED WELL 83 (Feet) 'May not be representative of a Tuelrrt king-term meld. <br /> DEPTH BORE- CASING (S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE HOLE TYPE FROM SURFACE TYPE <br /> DIA. MATERIAL I INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> Isl GRADE DIAMETER OR WALL IF ANY MENT TONITE FILL FILTER PACK <br /> Ft. to Ft. (Indus) THICKNESS (Indies) FL to FL (TYPEMIZE) <br /> ('�) (—') ('�) <br /> r 0 r 83 Portland I/II <br /> r l <br /> r i <br /> r <br /> r r <br /> ' ATTACHMENTS CERTIFICATION STATEMENT <br /> _ Geologic Lop 1,the undersigned,Certify that this report is complete and accurate to the best of my knowledge and belief. <br /> _ Well Cormtruction Diagram NAW Gregg Drilling and Testing,Inc. <br /> (PERSON,ARK OR CORPORATI(W (TYPED OR PRIMED) <br /> _ Geophyskal Log(a) <br /> Soi/Waeer Chemical A 950 Howe Road 55 <br /> y( other Site Plan ADDRESS Cm STATE IJP <br /> ATTACH ADDITIONAL INFORMATION, IF IT EXISTS. S"n 485165 <br /> '_13 <br /> LL ORRLE 11111EPRE3011111TIVE DAVE SIM C-57 UCEIISE MAW <br /> DWR 188 REV.11-9r, IF ADDITIONAL SPACE IS NEEDED, USE NEXT CONSECUTIVELY NUMBERED FORM <br />