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I <br /> 'The free Adobe Reader may be used to YAw and oonrl form. However,software must be purcha ad to complete,save,a', ise a saved form. <br /> File Original with DWR State of California r3 0Use Onl.=:Do'Ndf t=ill In <br /> Pa1 of Well Completion MR C <br /> 9e Rererto rnstrucllon Pamphlet State Well Number/Site Number <br /> Owner's Well Number MW-1 No. e0135518 N w <br /> Date Work Began 06/22/2011 Date Work Ended 6123/2011 AUG I U LUIldlitude Lon etude I <br /> Local Permit Agency <br /> Permit Number 0062753 Permit Date 6113/11 APNfrRSlOdier <br /> Orientation O Vertical O Horizontal OAngte Specrty Name hell 011 Products U <br /> I <br /> Drfiiing Method Hollow Stem Auger Drilling Fluid Mailing Address 20945 S Wilmington <br /> Depth froth Surface Da criptlon <br /> F.eSt et cm, %be'maienal; rarn.slze:color etc CI!X rSon State CA 7i 90815 <br /> 1 57 All well materials were drilled out to 57 fbq.. WeII:Locatioii. . <br /> Well was then tremle grouted with clean type 1111 Address 1313!Charter Way _ _- <br /> cement.Top of well covered with siol to match City S o coon County, San Joaquin <br /> existing surface. Latilud N`L`ongitude'`-= <br /> Dec. Min. Sec=;" ':Dao. Min. +sec. <br /> Datum Decimal Lit` = .Dedmal=Long.= <br /> APN Bock 151 Pagp 37 Parte!°-:007 :,, <br /> Township Ran a Sla tion <br /> ,�rww�.r•.�,� <br /> :BKeI,mu .O New well <br /> NbRh .,Q Modification/Repair <br /> Deepen <br /> O Other <br /> 4D Destroy <br /> Descdbe pracedurea mrd meteneh <br /> undo°GEOLOGIC LOG' <br /> ' _ a "Rl�nhed:lJses <br /> T Q Water Supply <br /> .� <br /> [I Domestic [I Public <br /> mil ❑Irrigation ❑Industrial <br /> i <br /> Q Cathodic Protection <br /> i' O Dewatering <br /> 4 O Heat Exchange <br /> 0Injection <br /> 0 Monitoring <br /> O Remediation <br /> O Sparging <br /> O Test Well <br /> S0 <br /> +x, ;y. trtueoale deecntea�+.�eaot nto� eaes.butmnp�.ten� O Vapor Extraction <br /> . Merq etc and attach a map l,r{e eddAbt'al paper r rcwauy. O Other <br /> e. <br /> Pleew accu[He vrd cam <br /> �., <br /> tetLevefdridFYiGld,bf:Ct1i: 1tpdUVel!* e'rs` •• "--.7,777 <br /> K s <- Depth to first water (Feet below surface) <br /> Depth-to Static <br /> WatelJLevel (Feet) Date Measured <br /> jr tla. Feet Estlm ted Veld' GPM Test Type <br /> Total Depth of Boring ;55 (GPM) y <br /> Total Depfh of„Completed Well Test ength (Hours) Total Drawdown (Feet) <br /> *Mi-v of be reresentatiiie of a well's long term yield. <br /> ,r,';3" 3 d.-,tl•= `"�- 5 -:s:.s:" ;s"�L:...«�'. � � p117� t �ff S _ 47-7 � ..aR ? 'l8aSIR . <br /> .. <br /> Depth from BoreholeARabBrl01 Well Outside Screen Slot Size Depth from <br /> Surface Dlameter,,x: yp Thickness Diameter Type if Any Surfers Fill Description <br /> Feet to FeetInc1ies'° �':�' inches Indies Inches Feet toFeet <br /> € 3 e p111� hmelttS ':._ r#. :aE3 ,W;'aa gr ° A., 1r�t :sx€.CettlflCattoet:5t gent , i <br /> E3 Geologic Log I,the undersigned,certify tthis report is complete and accurate to the best of my knowledge and belief <br /> [3 Well Construction Diagram Name Wb Ex ,oration&hat Wells <br /> Parson,Firm or Corporation <br /> ❑Geophysical Log(s) 1961 Meeker Avenue. Richmond _QA 94804 <br /> ❑SoiVWater Chemical Analyses city state zip <br /> ❑Other Signed A"?.&1111p— Alj?3L 283326 <br /> Attach additional information If It ordsts. C-57 Licensed water Well Contracrpr Date Signed C-57 License Number -7-1 <br /> DwR 1811 REV.1120M IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br /> �DG� 13/1j <br />