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01/31/2008 15:25 FAX 5108363036 GEOSYNTEC-OAK 1002 <br /> i <br /> 'The free Adobe Reader may be used to view and complete this form. However,software must be purchased to complete,save,and reuse a saved form; <br /> File Original with DWR State of California =c*' 't ; <br /> ` Well Completion Report G <br /> Page I Of Refer to/nsfruction Pamphlet State Well NumM�/Site Number <br /> Owner's Well Number /AW-7 No. eO67600 <br /> N `I 7 1I I W <br /> Date Work Began 'd/99/07 Date Work Ended.9/,7$JO7 Latitude Lon nude <br /> Local Permit Agency -��_Ieequ�adof anvtirv�N Floalth OCpertr-er+a" <br /> Permit Number 60 4J 691 Permit Date Wee/QZ APNITRS/ ther <br /> tllff3�LYe " <br /> Orientation INVertical O Horizontal OAngle Specify Name wesf-eIn Fc»n r2 Ln c. <br /> Drilling Method AdirM S,D h Li Drilling Fluid Mailing Address PO SOX 119;6' <br /> ptt' I;fnS c?r.,.De. P6on <br /> fi ur�fa4e.- C Etre s re State r Q3 715 <br /> „Feet, Descrltie material [airl,5izer colNx etc <br /> Q 13. i.ew+~Clew cf_ Ash Yello4tA hm—*% <br /> 13. 15 ao S r'd L.e-,,•a I. I Address 39I60 Saes, stare Rol.t ;33 i <br /> n 0yR 4 tri <br /> City �BA'�a1is C' i 5 n 5 <br /> qO <br /> Latitude 3715 I.q6IZ "i' 8 <br /> a tax t c Deo. Min. sac ,: 90L ea <br /> W G Datum k Decimal La y D dma i ong. <br /> a� ti. tC � APN Book ''Page M ' t�a�oef <br /> 2( 'AOLTownshipS Bari s <br /> o <br /> Pi <br /> ,.,;�-:: :�=krt. ,Kori ke Ij>..�_.Y:.^�:_:• °,:,R._,_:.` 'cbY 'a�.:,:,,,,a. <br /> 'sketohnaat.be drawn b hang armrb Ni*Well <br /> v�8 4 i C{a. fJorth <br /> �.(�;MtiidificatioNRepair <br /> 5 $C Oar w. rt�v�r� � Ir�a-Gl � yry =¢O Deepen <br /> 3 6 WA.A CsLa) DGr I-cO Other <br /> r <br /> K <br /> I Destroy <br /> Gy�1A� Da "procedtaea wd matalab <br /> G 4- M Qa Y► -dn'GEOLOGIc LOG• <br /> 10 tkki frRI inh d: <br /> O 16 W Y' O-Mater Supply <br /> \ Domestic ❑Public <br /> y C3"ation ❑industrial <br /> �.. �' s U1 O <br /> d W n ' �, (Cathodic Protection <br /> Dier <br /> O Dewatering <br /> I^ILejw, �- h���` �, u °aa-o:`•`• OFieatExchange <br /> t� 4, O Injection <br /> 19 Nonitoring <br /> O Remediation <br /> ,- O 1Test Well <br /> 2i c: ^y`` ,?i.. '• •South <br /> tlYiwata or dna(-di OW—M 1-4tram roads,buN",lance, Oj�VapOr Extraction <br /> riven,M.and attach■map.Use addlb nW paper it actuary. O!Other <br /> Please be aecan0a and a IeOe. 9 <br /> 6. <br /> `;K` <br /> t' w. .. iter Leve andYiel 'of,; ial fife eih'Y:::;.%, <br /> R1 <br /> Depth to first water 30.H (F4et below surface) <br /> Depth to Static f <br /> Water Level O (Feet) Date Meaured /a7I07 1. <br /> Total Depth of Bbnrig' y „Feet' Estimated Yield ) (GPM) Test Type4 tJ/A% <br /> • Test Length (Hours) Total Drown 1.7 (Feet) <br /> Total Depth gfiCompleted Well Feet <br /> :: -May not be representative of a well's long term yfeld. <br /> '` ” F' �• y casiM "s - ? .Ari_4TiilaMiNPaferigl_.. <br /> Depth from hole 1,. e F a-,, 'Material Wall Outside Screen Slot Size Depth from <br /> Surface Dani Thickness Diameter Type if Any Surface Fill Description <br /> Feet to Feet Indies _",. inches Inches Inches Feet to Feet <br /> Oat 1 6 5.4-;Aq 0 PV G — o Ar►n irr se, + C>+w +a- <br /> .Z H •S `rf S40; 9V G. — — O•Oaa 1 I <br /> 44 Swed ask on 4� <br /> 114tta6 i'ti nts CertificationEStatemeiit <br /> .; <br /> $l Geologic Log 1,the undersigned,certify that this report is complete and accurate to the best of rrty knowledge and belief <br /> L`1 Well Construction Diagram Name GREGG DRILLING&TESTING, INC.Pars Firm or <br /> ❑ Geophysical Log(s) 950 HOWE R0A.D, po ton MARTINEZ CA x94553 <br /> ❑ SoilNVater Chemical Analysesd - ciry state }, zip <br /> 13 Other Signed7--e 4851 6 <br /> It Attach additional I aeon it it exists. C-57 Uoiifsad Water WeN Contractor Date Si ned C-57 License Number <br /> DWR 188 REV.112006 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br /> M <br />