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'The free Adobe Reader maybe used to view and complete this toren. However,software must be mrchased to complete,save,and reuse a saved form. <br /> File Original with Di State of California DWR Use Only-Do Not Fill In <br /> Well Completion (Report � )—fir <br /> Page 10 of 42 Refer to in5rmcrion Pani of <br /> State Well Number/Site Number <br /> Owner's Well Number MW-51B No. e0162823 � �n <br /> Date Work Began 09/24/2012 Date work Ended 10/1/2012 Latitude Lon itutla <br /> Local Permit Agency San Joaauin County Environmental Health Department . <br /> Permit Number NA Permit Date APN/TRS/Omer <br /> Geologic is Lo Well Owner <br /> Orientation @Vertical @Horizontal OAngle Specify Name <br /> Drilling Method Hollow Stem Auger Dnlling Fluid Bentonite mud Nailing Address <br /> Depth from Surface Description <br /> Feet to Feet Describe material, rain size,color,etc Cit State---Zip <br /> 51 0 Pressure Grout Well Location <br /> Address 6437 West Banner Street <br /> City Lodi County San Joaquin <br /> Latitude N Longitude __�N <br /> Dep. Min. Sec. Oea. Min. Sec. <br /> Datum Decimal Lat. Decimal Long. <br /> PAN Book Page Parcel <br /> Townshi Range. Section <br /> 1 Location Sketch Activity <br /> Sketch must oe drawn by hand after for,is nnted. 0 New Well <br /> North O Modification/Repair <br /> O Deepen <br /> O Other <br /> Destroy <br /> under'G'GEOLOGIC <br /> G'mems•le <br /> vnaer'eEoloGle LOG' <br /> Planned Uses <br /> O Water Supply <br /> ❑Domestic []Public <br /> 1l w ❑Irrigation []Industrial <br /> O Cathodic Protection <br /> O Dewatering <br /> O Heat Exchange <br /> O Injection <br /> O Monitoring <br /> O Remediation <br /> O Sparging <br /> South O Test Well <br /> k <br /> eerolb•aetsoc•of caro r,om,•ads.mmdino.neoem. O Vapor Extraction <br /> ne.ire.n•chaaao.ueodebm�.l N•eere•emsaerv. O Other o•b•.«•am,ne can tem <br /> iter Level and Yield of Completed Well <br /> Depth to first water (Feet below surface) <br /> DP.pth to Static <br /> Water Level (Feet) Date Measured <br /> Total Depth of Boring 51 Feet E!,imaled Yield (GPM) Test Type <br /> Total Depth of Completed Well 51 Feet Test Length (Hours) Total Drawdown (Feet) <br /> 22fay not be representative of a well's long term yield. <br /> Casings Annular Material <br /> Depth from Borehole Type !fateful Wall Outside Screen Slot Size Depth from <br /> Surface Diameter Thickness Diameter Type if Any Surface Fill Description <br /> Feet to Feet Inches _ Inches Inches Inches Feet to Feet <br /> Attachments Certification Statement <br /> ❑ Geologic Log I,the undersigned,certify that this eport is complete and accurate to the best of my knowledge and belief <br /> ❑ Well Construction Diagram Name All Well Abandonment . <br /> ❑ Geophysical Lo (S Person,Firm or Corporation <br /> Log(s) 9245 Beatty Drive Suite & _.�.&a men CA 95826 <br /> ❑ Soil/Water Chemical Analyses Ad 's. tiny state zip <br /> D Other Site May Signed . 10/23/2012 848359 <br /> Austin additional information if it ousts. C-Sl Li.enr�eterWet Cori'actor Date Signed C-57 License Number <br /> Di 180 REV.112006 IF ADDITIONAL SPACE is NEEDED,USE NEXT CONSECUTIVELY NUMBEREOFORM <br />