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ORKtiIMAL STATE OF CALIFORNIA DWR USE ONLY — DO NOT FILL IN <br /> File with DWR WELL COMPLETION REPORT <br /> Page 1 of 1 Refer to Instruction Pamphlet STATE WELL NO./STATION NO. <br /> Owner's Well No.-MW-3 No. e027934 <br /> Date Work Began 7/19105 Ended 7/19/05 LATITUDE LONGITUDE <br /> Local Permit Agency San Joaquin County Department of Environmental Health <br /> UU42542 6/1/05 AP WTRSlOTHER <br /> Permit No. Permit Date <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION VERTICAL _HORIZONTAL _ANGLE _(SPECIFY) Name- Chevron Environmental L{Wnaement <br /> DEPTH FROM <br /> METHOD FLUID Mailing Address Nb k3ox 6012' <br /> SURFACE DESCRIPTION San Ramon CA 945V,-- <br /> Ft. to FL Describe material, grain si=e, color, etc.' CITY STATE ZIP <br /> WELL LOCATION <br /> Address 25651 North Highway 99 <br /> 0 1 83 1 Portland 1/II Cement •Ciry Acan1DO <br /> County San Joaquin <br /> ' APN Book 005 Page 141 parcel 20 <br /> ' Township Range Section <br /> 1 1 Latitude I I NORTH Longitude I I WEST <br /> - DEG. MIN. SEC. DEQ MFiL SEC. <br /> LOCATION SKETCH ACTIVITY (2!�.) <br /> NORTH <br /> — NEW WELL <br /> r 1 <br /> MODIFICAYIOWREPAIR <br /> 1 1 —O—pen <br /> 1 1 --Other(SP.cilr) <br /> DESTROY(Dow," <br /> ProCWrree aW AfNNIMd <br /> undw"GEOLOGIC LOG') <br /> PLANNED USES <br /> 1 1 WATER SUPPLY <br /> — Daaeelic Public <br /> r 1 <br /> f irrigation Irlduslriel <br /> w MONITORING— <br /> 1 I TEST WELL— <br /> 1 1 CATHODIC PROTECTION— <br /> t 1 <br /> HEAT EXCHANGE— <br /> DIRECT PUSH— <br /> INJECTION— <br /> ' ' VAPOR EXTRACTION— <br /> I I SPARGING— <br /> 1 1 SOUTH REMEDIATION- <br /> illustrate or Describe Distance of Well(ronl Roods,Buildings OTHER(SPECIFY) <br /> 1 1 Fences.Ricers,etc.and-ac nmay Use addftional paper i� FY)— <br /> necessan�.PLEASE BE ACCt/RATE it COMPiETE. <br /> / 1 <br /> I 1 WATER LEVEL Qt YIELD OF COMPLETED WELL <br /> 1 DEPTH TO FIRST WATER (FL)BELOW SURFACE <br /> 1 DEPTH OF STATIC <br /> WATER LEVEL (FL)d DATE MEASURED <br /> r 1 <br /> ESTIMATED YIELD' (GPM)i TEST TYPE <br /> TOTAL DEPTH OF BORING 83 (Feet) TEST LENGTH (Hts.)TOTAL DRAWDOWN._(FL) <br /> TOTAL DEPTH OF COMPLETED WELL 83 (Feet) 'May not be representative of a welCs Jong-ter m yield. <br /> DEPTH BORE CASING (S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE HOLE TYPE FROM SURFACE TYPE <br /> DIA. MATERIAL/ INTERNAL GAUGE SLOT SIZE CE• BEN <br /> (trches) GRADE DIAMETER OR WALL IF ANYMENT ONITE FILL FILTER PACK <br /> Ft. to FL J (lrtdtee) THICKNESS (blchm) FL to FL (�) (=) (�) (lYPEISIZE) <br /> 1 0 1 83 Portland 1/II <br /> I <br /> 1 , <br /> I <br /> 1 , <br /> 1 1 <br /> ATTACHMENTS CERTIFICATION STATEMENT <br /> Geologic I,the undersigned,certify that this report is complete and accurate to the best of my knowledge and belief. <br /> WON Corn Dram ,AE Gregg Drilling and Testing,Inc. <br /> Geopt"IcM Lop(s) JKRSOK nRK DR CDRPDRA7M (TTrED OR PRRRED) <br /> _ SOWWater ChemkW A 950 Howe Read,Martine CA <br /> OBter Site Plan ADDRESS CRY�'7 St Zr <br /> ATTACH ADDITIONAL INFORMATION,♦F/T EXISTS. SJynsd 9 7 485165 <br /> Wga&i ATNE DA SVIED C-57 LICENSE NUMBER <br /> DWR 188 REV.I1-97 IF ADDITIONAL SPACE IS NEEDED, USE NEXT CONSECUTIVELY NUMBERED FORM <br />