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ORIGINAL STATE OF CALIFORNIA R R USE ONLY - no N <br /> File with DWR WELL COMPLETION REPORT F I I I <br /> STATE WELL Nol5TATION NO <br /> . Page--L—of- I Refer to Instruction Po,Ilphlef ❑ ❑ <br /> Owners Well Na B "°� 749259 <br /> to Work Began MARCH 5.2 20LATITUDE LONGITUDE <br /> 2_—, Ended MARCH 5,2002 <br /> Local Pernut Agency, SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES-ENV DIV APIf1TRSIOTHER <br /> Permit No 289131 Permit Date FEBRUARY 22.2002 <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION (4) ✓VERTICAL —HORIZONTAL _ANr$E _tsruc Fn Name LIOCA <br /> DRILLING <br /> DEPTHFROU METHOD Hollow Steam Auger FLUID NONE Marling Address 8788 ELK GROVE BLVD BUILDING 3.SUITE 15 <br /> SURFACE DESCRIPTION ELK GROVE CA 5562 <br /> FL to FL Descnbe Fnatenal graun size color, etc crnr STATS zip <br /> Address <br /> 0 , 60 I WELL BORING WAS NOT LOGGED OR SAMPLED WELL LOCATION <br /> I City SM .KTC)N.CA <br /> r County SANJOAQ <br /> APN Book Page Parcel <br /> r Township Range Section <br /> I "ttitude INORTHLonptude WEST <br /> DEB MRN SEC DEO MIN SEC. <br /> ' ILO ON S)EETCH ACTIVITY (_) <br /> 1 r - # � ;' ✓ NEW WELL <br /> MODIFICATIONIREPAIR <br /> I I lam' meg( , T Other(Spseily) <br /> DESTROY(D""" <br /> �- ,1 Amdvr' E Intl AI LOG <br /> ffrlaNr'CaEQLOGfCLQG7 <br /> fflaft <br /> * ' = PLANNED USES (4) <br /> 1 WATER SUFftY <br /> 11 <br /> r I 1 _, Iowar ar� , f sT <br /> Domsslfe Pubsc <br /> ' I t; ust's 1 v-sc ern lnipsosn Industrial <br /> WA—xY � MONITORING <br /> I r „ a � TEST WELL <br /> , ��+ s }�'s srws! 1+ CATHODIC PROTECTION— <br /> Erg" I�r siwi ,1} HEAT EXCHANGE <br /> 1 f% <br /> vrrle' 1 rCYFN7 $$ E, DIRECT PI/SH_ <br /> I Slallo,r i 1 e Gil Mw.t= INJECTION r <br /> Tnrh yr 1 vAPOR ExTPACTK)N <br /> I I V MV04 ` SPARGING <br /> + 1 <br /> r 1 REsIEDIATION <br /> r t (is,k W A� <br /> t a to OTHER;SPECIFY)_ <br /> BuNfing on" <br /> r I WATER LEVEL & YIELD OF COMPLETED WELL <br /> r r <br /> DEPTH TO FIRST WATER (FL)BELOW SURFACE <br /> � r <br /> DEPTH OF STATIC <br /> WATER LEVEL (FL)9 DATE MEASURES] <br /> ' I ESTIMATED YIELD • (GPM) & TEST TYPE -- <br /> TOTAL DEPTH OF BORING s0 (Feel) TEST LENGTH (Dual TOTAL DRAWDOWN—(FI) <br /> TOTAL DEPTH OF COMPLETED WELL BO (Feet) May not be rlepruratauve orR weirr Ion -td 1A ylelik <br /> CASING (S) DEPTH <br /> ANNULAR MATERIAL <br /> DEPTH FROM SURFACE SURFACE HOLE TYPE FROM SURFACE TYPE <br /> DIAz d MATERIAL r INTERNAL GAUGE SLOT SIZE CE- Belt <br /> (��1 W E GRADE DIAMETER OR WALL IF ANY MEET ONITE FILL FILTER PACK <br /> A to Ft. Irs ;j�I w <br /> fess) THICKNESS (Inthw) FL to IR (�) (�) (=' (TYPFAIZfE}) <br /> 0 I 575 8 ✓ PVC 075 SCh 40 0 50 ✓ <br /> 575 I GO 8 ✓ 2 Mlcrosparge 50 r 55 ✓ <br /> 55 r 60 ✓ 2/12 Lonestar <br /> r <br /> Sand <br /> r <br /> r 1 <br /> ATTACHMENTS (4) CERTIFICATION STATEMENT <br /> !,the undersigned Certify that this report Is complete and accurate to the best or my knowledge fend belief <br /> C3eoltl((pc U)g <br /> G <br /> WOODWARD DRILUNG <br /> — Well�$}��D AWHE iPER M THIN OR CDRPORATIOIQ (TWED OR PffIR ED) <br /> anpryslcal Lag(a) 550 RIVER ROAD I P O BOX 336 RIO VISTA CA 94571 <br /> — SoMater Chern=1 Analyses GrY STATE IIF <br /> ...._ Other ADDRESS <br /> arrACH anDrrllfutL INFORM TIM 1F fr EXISTS �� JUNE 13L2002 710079 <br /> WELL R o REPRESERTATIYE OAT[SIGHED (r5T UCf1N5E III HER <br /> Dl1R Las REV 11.9; IF ADDITIONAL SPACE ISN DED, USE NEXT CONSECUTIVELY NUMBERED FORM <br />