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saved <br /> The tree Adobe Reader may be used to view and complete this form. However,software must be purchased to complete,save,and reDuseaUEAPWTIRSIOther <br /> rmDo Not Fill In <br /> State of California _File Original with DWRWell Completion Report ( tRererto insvuction Pamphlet State Wber�lI NumberV1of 1 l i I i I �Page 1_ No. e0078891 �--1__-___1 :1 Lon nude <br /> Owner's Well Number MW-4 Latitude <br /> Date Work Ended $18!700_-- I tDate Work Began 08108/2008 Inn i <br /> Local Permit Agency 6!17/08 <br /> Permit Number cattnn54570 Permit Date Well Owner <br /> Geolo is Lo <br /> QAngle SpeciTy Name Chevron Environmental Mana ement om an <br /> Orientation Overtical QHorizontal <br /> Dniling Fluid ________-- Mailing Address 6001 Bollinger Can on Road.Room K 0 83 2324 <br /> Drilling Methoa DescriptionCit San Ramon <br /> Depth from Surface <br /> Feet to Feet Describe material, rain size,color,etc Well Location <br /> 0 <br /> 45 Bonri drilled out to total depth using_8-iin ______ <br /> diameter augers,backfilled with neat cement, Address 35275 Welt Road County San Joaquin <br /> and topped with a 6-inch black-dyed concrete City Vernalis <br /> _ Latitude N Longitude Deo M;n sec <br /> cap. Dea. Mm Sec <br /> Decimal Long <br /> Decimal Lat. . <br /> Datum_ <br /> 09 <br /> Pae 180_____— Parcel <br /> APN Book,25a - 9 <br /> Ran e <br /> Townshi sectionActivit <br /> Location Sketch New Well <br /> (sKetch muss be drawn b form hard after fois rimed. <br /> Norah Q Modification/Repair <br /> 0 Deepen <br /> p Other <br /> Q Destroy <br /> "de'G C0I<0GtC a'�matctiak <br /> c�av'GEOLO�iC LOO' <br /> Planned Uses <br /> – Q Water Supply <br /> ©Domestic [:]Public <br /> ,y ❑Irrigation ❑Industrial <br /> Q Cathodic Protection <br /> Q Dewatering <br /> 0 Heat Exchange <br /> Q Injection <br /> O Monitoring <br /> 0 Remediation <br /> 0 Sparging <br /> 0 Test Well <br /> South Q Vapor Extraction <br /> itivxe Ides Oi dataus OF-i' ro+es"'oN3.'c 0Other <br /> r•.ve-s.enc reseac•ramaF ,.19,-r!ra.� •ecess: <br /> Please lx accurate and c.-let, <br /> ater Level and Yield of Completed Well <br /> 1 Depth to first water (Feet below surface) <br /> Depth to Static <br /> Water Level (Feet) Date Measured <br /> Estimated Yield' (GPM) Test Type <br /> Total Depth of Boring 45 Feet <br /> Test Length (Hours) Total Drawdow- eeO <br /> Total Depth of Completed Well N/A Feet 'May not be representative of a ue-s _^o term yield <br /> Casings Anular Material <br /> Depth from Borehole Type Material wait Outside Screen Slot Size Depth from <br /> ype <br /> Surface Diameter Thickness Diameter Type if Any Surface Fin Det Do <br /> Feet Io Feet Inches Inches Inches Inches Feet to Feet <br /> 0 145 JCement <br /> I <br /> — L <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 /> 0 Well Construction Diagram Name RSI Person, <br /> n <br /> Firm or Corporation <br /> Geophysical Log(s) 220 N. East Street Woodland GA 95776 <br /> ElSoil/Water Chemical Analyses Add ass C1yC state <br /> Zip <br /> (�Other Site Map Signed (L v3 802334 <br /> .attadm additional intorrnaUon.if�t e gists ��- to Signed C-57 License Number <br /> 7 Licensed Vt�'ater Well on dot <br /> D'WR 188 REV.111. IF ADDITIONAL SPACE is NEEDPD. SE fJ T CONSECUTIVELY NUMBERED FARM <br />