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'The tree Adobe Reader may he used to view and com, 'his form. However,software must be purchased to compleb 3.and reuse a saved form. <br /> File Original with DWI State of California DNR Use Only-Do Not Fill In <br /> Page 1 pr 1 Well Completion Report <br /> Referto Instrvcfron Pamphlet �- State Well Number/S2e Number <br /> Owner's Well Number MW-1 No. e0084199 L IN� w <br /> Date Work Began 11/18/2008 Date Work Ended 11/18/2008 Ledtutle Lon nude <br /> Local Permit Agency San Inon in Cn n1y Environmental Health Department <br /> Permit Number 55901 Permit Date 11/13/08 APN/TRS/Other <br /> Geologic LouWell Owner <br /> Orientation OVertical 0Horizontal OAngle specify Name BP/ARCO <br /> Drilling Method Hollow Stem Auger Drilling Fluid Mailing Address 4 centeroc inte drive <br /> Depth from Surface Description <br /> Feet to Feet Describe material,train sue,color,etc City La Palma State CSI <br /> Boring drilled out with 10"augers to a depth of Well Location <br /> 75 feet bgs. Boring was then backfilled to 2round Address 6100 North Hwy.99 <br /> surface with neat cement. City Stockton County San Joaquin <br /> Latitude N Longitude ___w <br /> Dea. Min. sec. Deal. Min. Sec. <br /> Datum Decimal Let. Decimal Long. <br /> APN Book Page Parcel <br /> Township —Range Section <br /> Location Sketch Activit <br /> Sketch must be drawn by heManerform is anted. 0New Well <br /> North 0 Modification/Repair <br /> O Deepen <br /> O Other <br /> Destroy <br /> D.—Ii.ammm.n am m.me.m <br /> arca GEOLOGIC LOG' <br /> Planned Uses <br /> 0 Water Supply <br /> ❑Domestic []Public <br /> 3 w ❑Irrigation ❑Industrial <br /> 0 Cathodic Protection <br /> 0 Dewatering <br /> 0 Heat Exchange <br /> O Injection <br /> O Monitoring <br /> O Remediation <br /> O Sparging <br /> South O Test Well <br /> aaasn..,e..<ns.ma.o<a of w.x eom.o.n.,bmltios..r<�a.. 0 Vapor Extraction <br /> v ..m.imp aeach a map,u...aab�a pap<,n a.cessmy 0 Other <br /> l..s•b.•mrw.am—lama. <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 /> Total Depth of Boring rj Feet Estimated Yield (GPM) Test Type <br /> Test Length (Hours) Total Drawdown.(Feet) <br /> Total Depth of Completed Well Feet Lmay not be representative of a well's long term yield. <br /> Casings Annular Material <br /> Depth from Borehole T Material Wall Outside Screen Slot Size Depth from <br /> Surface Diameter Type Thickness Diameter Type if Any Surface Fill Description <br /> Feet to Feel Inches Inches Inches Inches Feet to Feet <br /> III Q <br /> Attachments Certification Statement <br /> ❑ Geologic Log I,the undersigned,cediffyy that this report is complete and accurate to the best of my knowledge and belief <br /> 13 Well Construction Diagram Name Woodward Drillina Company <br /> ❑ Geophysical Lo s Parson,Finn or Corporation <br /> Y 9( ) 550 River Roa Rio Vista CA 94571 <br /> ❑ SoltWater Chemical Analyses Ares Ciry Slate zip <br /> ❑ Other Signed 710079 <br /> Arson addiumal milmraeon it it exists. C-5] censea water wet Cantredor D eSi ned C-57 License Number <br /> DWR 188 REV.112005 IF ADDITIONAL SPAIIE IS NEEDED,USE NEXT CONSECUTIVELY AtIMBERED FORM <br />