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OIRWAINAC STATE OF CALIFORNIA DWR USE ONLY — DO NOT FILL IN <br /> File with DWR OLL COMPLETION REPOR <br /> Page 1 of 1 Rcfer to Listructinn Pcnnpblel STATE WELL NO./STATION NO. <br /> Owner's Well No. MW1 — MW3 NO. 725944 E <br /> Date NVOI'k Began 11 Ended 08/11 /00 LATITUDE LONGITUDE <br /> Local Permit Agency San Jnaqui n o unt-y Puhl i r Hea 1 t-h <br /> Permit No. 023643 Permit Date 07/31100 APN/TRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION (_�L) —VERTICAL —HORIZONTAL —ANGLE —(SPECIFY) Nalne Ea R t C i rip w i nery <br /> DRILLING <br /> DEPTH FROM METHOD J;j $-A FLUID Mailing Address 61 00 Ra St H i g—h�y 1 2 <br /> SURFACE DESCRIPTION Lodi, CA 4 <br /> Ft. to FL Df.scribe mater-ial, j;l"dill Si;�C, Color, etcCITY STATE ZIP <br /> WELL LOCATION <br /> Address Field at Highway 12 & Hwy. 99 <br /> I <br /> city Lodi <br /> Comity San Joaquin <br /> attached well logAPN Book Page Parcel <br /> Township 4N Range 7E Section 31 <br /> Latitude_ I I NORTH Longitude_ WEST <br /> I DEG. MIN. SEC. DEG. MIN. SEC. <br /> LOCATION SKETCH <br /> NORTH ACTIVITY (.�L) <br /> _X_ NEW WELL <br /> MODIFICATION/REPAIR <br /> I I <br /> Deepen <br /> I _ Other(Specify) <br /> I I <br /> Please see <br /> attched site plan — DESTROY(Describe <br /> Procedures and Materials <br /> Under"GEOLOGIC LOG') <br /> i I <br /> PLANNED USES (�) <br /> I I <br /> WATER SUPPLY <br /> I — Domestic _ Public <br /> I <br /> ` _ Irrigation _ Industrial <br /> w MONITORING <br /> TEST WELL <br /> CATHODIC PROTECTION <br /> HEAT EXCHANGE <br /> I DIRECT PUSH <br /> INJECTION <br /> VAPOR EXTRACTION <br /> SPARGI NG <br /> SOUTH REMEDIATION <br /> Illushcde or Describe Distance of II'ell from Roads.Huildirl-s. <br /> I Fences,Rircrs,eh'.(incl otlnell ci mall. t',additiuncd�(lpvr iF OTHER(SPECIFY) <br /> necessary.PLEASE BE ACCURATE v COMPLET . <br /> I i <br /> WATER LEVEL & YIELD OF COMPLETED WELL <br /> DEPTH TO FIRST WATER (Ft.) BELOW SURFACE <br /> I I DEPTH OF STATIC <br /> WATER LEVEL (Ft.)&DATE MEASURED <br /> i I <br /> ESTIMATED YIELD ' (GPM) & TEST TYPE <br /> TOTAL DEPTH OF BORING (Feet) TEST LENGTH (Hrs.)TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF COMPLETED \VELE (Feet) May riot he representative of a well's long-tern yield. <br /> DEPTH CASING (S) DEPTH ANNULAR MATERIAL <br /> BORE- <br /> FROM SURFACE HOLE TYPE() FROM SURFACE <br /> TYPE <br /> DIA. Y w om a MATERIAL/ INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> (Inches) g ¢ zoo GRADE DIAMETER OR WALL IF ANY MENT TONITE FILL FILTER PACK <br /> Ft. to Ft. m �o _� (Inches) THICKNESS (Inches) Ft. to Ft. (TYPE/SIZE) <br /> I <br /> I <br /> I <br /> I I <br /> ATTACHMENTS CERTIFICATION STATEMENT <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 Cascade Drillina, Inc <br /> (PERSON, FIRM, OR CORPORATION) (TYPED OR PRINTED) <br /> Geophysical Log(s) <br /> Soil/Water Chemical Analyses <br /> Other ADDRESS CITY STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION, IF IT EXISTS. Signed <br /> WELL DRILL IbED REPRESENTATIVE ATE SIGNED 1-3 LIC71S51 INUPBER <br /> I)WE IRS REQ. II-97, IF ADDITIONAL SPACE IS NEEDED, USE NEXT CONSECUTIVELY NUMBERED FORM <br />