SITE INFORMATION AND CORRESPONDENCE

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01/31/2008 15:26 FAX 5108363036 GEOSYNTEC-OAK 4 006 '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. File Original with DWR State of California DWR Use Only Do Not Fill In Page I of t Well Completion phReport Reter to Instruction let State Well Numiier/Site Number Owner's Well Number No. e067600 Date Work Began?1:7/67 Date Work Ended 9�,�7/d 1 Latitude N Longitude W Local Permit Agency 51— S�µt^ CoNrltr Gn\ ort<en-*\ 14ea\-t4+ �t $ Permit Number 2251 G 97 Permit Date L-ag/o7 APNTrRSiother Geologic Log Well Owner Orientation $Vertical 0Horizontal OAngle Specify Name We-S}ern EM= SttyioGl ir%c Drilling Method 1 o16-3Dt;, ALODrilling Fluid Mailing Address PG Depth from Surface Description Box )tC>� Peet to Feet Describe material,grain size color,etc CityI'n.SnO State's LA i O 8.5 S.If NO 01ive($V 4S*/0 a 1560 Well Location 441* Address 3 310() 5anfh S+otQ )3.5 Lear\ C1a. G , 61;,e kel, C�:b l 'i/9 City Ve{nal i5 County San 50aQw r% loo10/0 �; a'st lora a +�e��u^ Latitude 37 �_ 1•�ZJ N Longitude 121 17 may,/ Deo Min. Sec. ii Dec. Min Sec Datum Decimalt':6333040.67 Decimal `tvq--ao5916;2- 7 vK. ew e� APN Book Page Parcel a551V0 f� / I 1$. a Qty t• a TownshipOSS �k�Range Section 3y r suborn �1ar Location Sketch Activity Sketch must be dra n by hand after form is pnnted. New Well 1 O . S err k rat tr North Modification/Repair I :1rr O O Deepen aZ o2 02 Welt cn 5"A i I�+ v-L Mu r O Other vU d 1+ as .7•$l' d) Destroy I `it Describe Procedures and materials L eL,, �G L M 1 el��wr 5 f undWGEOLOGIC LOW 9drl " I Planned Uses vZ 3 .5 5 Si I t- W i i�. S411CI &AL P k 6\ik \ Q Water Supply ,![]Domestic ❑Public F Gr°Y j Ot:R \. Lu ❑Industrial r G,l v- w t Su+d C6P�GM �� d Cathodic Protection Mw-7 b Dewatering t+JGll Grocu.A S SW putt elbwi O\ (p Heat Exchange 6 Injection $ 5 S6.6 Wall r !�,rave( W 011 Monitoring 36. - 33.5weltC'lo, (Sw pp.ti� K�oroi C Remediation Sparging rj 3'1-5 Lv e\\ ( odd 6 w fqU; S-e SoNh Test Well e p �L,r,, / IIIWtrebe0,describeaistanceofweufromroads.buildin fences, O VaporExtraetion 3 5• 1 I�f t r i+t�r�`♦ 1L� U rivers,etc.and ettch a map Use addrdonol paper if—essary. Q Other 35 3� e W 1 (� Phase be accurate and cirri late. Otter Level and Yield of Completed We 3 37 We \ Depth to first water 311 ,5'1 (Feet below surface) 37 �'S LBcr+ G1�. Gf" Depth to Static j 3`115 /(c{ We roc1Gc�i �5 W __ Water Level 31. (Feet) Date Measured S off$/07 Total Depth of Boring 4141 Feet Estimated Yield` (GPM) Test Ty�e tJr/�c Total Depth of Completed Well ) �" Feet Test Length 4+Cd (Hours) Total Dr wdown 7. L (Feet) *May not be representative of a well's long term 'eld. Casings Annular Material Depth from Borehole Type Material wall Outside Screen Slot Size Depth from Surface Diameter Yp Thickness Diameter Type it Any Surface Fill Description Feet to Feet Inches Inches Inches inches Feet to Feet 8 SLN"t0 I PV C- ;Z " — 0 t _ N + Ger 1 '-f Sc It qo P u G -- — a.off" I I Ir 6irm-ir- -P r v d Ctrb- – Ig _ =a► � s 4 0 I Attachments Certification Statement ®Geologic Log 1,the undersigned,certify that this report is complete and accurate to the best of my knowledge and belief ®Well Construction Diagram Name GREGG DRILLING 8f TESTING, INC. PersonLog(s) 950 HOWE ROAorCorpo ti Fi Geophysical L son MARTINEZ CA 94553 ❑ ❑Soil/Water Chemical Analyses fdr &5 Stele zip ❑ Other Signed 485165 Attach additional Inforinabon if it exists. C-57 Lr sed Water Well Contractor Date SI ned C-57I,1-lcense Number DWR 188 REV.1/2006 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM