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'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 DWR Use Only—Do Not Fili In <br /> Page or 1 Well Completion Report <br /> zeter to Msrtuction PampWe[ <br /> Owners Well Number MW-4 No. e00788911 State WI N [—I <br /> Number! -Number Owners <br /> Date Work Began 08108/2008 Date Work Ended 818!2008 I Latitude Longitude <br /> Local Permit Agency San joacluin Couaty Environmental <br /> Permit Number.SR#0054570 Permit Date 6117/08 APNITRS10ther <br /> Geologic Log Well Owner <br /> Orientation QVertical 0Horizonte I OAngle specify Name Chevron Environmental Management Coman <br /> Drilling Method Drilling Auld Mailing Address 6001 Ballinger Canyon Road,Room K2066 i <br /> Depth from Surface description San Ramon CA 94583-2324 <br /> Feet to Feet Describe material, rain size color,etc Cit State <br /> 0 45 Boring drilled out to total depth using 8-inch Well Location <br /> diameter augers, backfilled with neat cement, Address 35275 Welty Road <br /> and topped with a 6-inch black-dyed concrete City VernalisCoun ty San Joaquin <br /> cap' Latitude N Longitude �v <br /> Dea. Mm Sec. Del) Mm Sec <br /> Datum Decimal Let. Decimal Long. <br /> APN Book.255 Page_180 Parcel 09 <br /> Townshi Ran a Section <br /> Location Sketch Activi <br /> Sketch must be drawn by hand after form is noted. New Well <br /> North ❑ Modification/Repair <br /> Q Deepen <br /> ❑Other <br /> Destroy <br /> oescrioe proeedu and mater�ahs <br /> under'GEOLOGiC LOG' <br /> Planned Uses <br /> ❑ Water Supply <br /> OlDomestic ❑Public <br /> ❑Irrigation ❑industrial <br /> LU ❑ Cathodic Protection <br /> Q Dewatering <br /> ❑ Heat Exchange <br /> ❑ Injection <br /> ❑ Monitoring <br /> ❑ Remediation <br /> ❑ 5parging <br /> South ❑ Test Well <br /> ousuate oreaeerun matinee aI wew nom meds,buudings.tcnces ❑ Vapor Extraction <br /> etc and auacss a mau rise addAianai paper it necessai•; ❑Other <br /> Pinsu be aeeuraee■ne cam lets. <br /> Water Level and Yield of Completed Well <br /> Depth to first water (Feet below surface) <br /> Depth to Static <br /> Water Level (Feet) Date Measured <br /> Total Depth of Boring 45 Feet Estimated Yield` (GPM) Test Type <br /> Total Depth of Completed Well SIA Feet <br /> Test Length (Hours) Total Drawdown (Feet) <br /> •May not be representative of a well's long term yield. <br /> Casings Annular Material <br /> Depth from Borehole T Material Wall Outside Screen Slat Size Depth from <br /> Surface Diameter Type Thickness Diameter Type If Any Surface Fill Description <br /> Feet Io Feet Inches Inches Inches inches Feet to Feet <br /> 0 45 Cement <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 RSI Drilling <br /> Person,Firm or Corporation <br /> ❑Geophysical Log(s) 220 N. East Street Woodland CA 95776 <br /> ❑SoillWater Chemical Analyses Addresscity stats Zip <br /> El Other Site Mata Signed f 111'LA 802334 <br /> Attach addrhonal information if rl exists 7 Licensed Weser well v star 0late Signed C-57 License Number <br /> t <br /> O1NR 188 REV.12006 IF ADDITIONAL SPACE IS NEEDED, S>_N T CONSECUTIVELY NUMBERED FORM <br />