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1 I <br /> *The free Adobe RBader may be used to view and complete this forth. Hawever,saflware must be pumrias d to complete,save,and reuse a saved form. <br /> File Original_with DWR State of California <br /> Page 1 of 1 Well Completion Report { <br /> ReferrornaUudlonPamphb t State Well NumberlSite Number <br /> Ownees Well Number MW-6 No. e0135549 " N <br /> Date work Began 06/21/2071 Date Work l=nded 6/23/2011 Latitude. ton Rude <br /> Local Permit AgencygANlTRS! thar <br /> Permit Number 0062753 Permit Date 6113111 <br /> Orientation O Vertical O Horizontal OAngla speGiry. Name hell Oil Products US <br /> orunng Medaod Hollow stem nu ar Drilling Fluid Maiting Address 20945 S Wilmin6ton <br /> q�rs6n State CA _zlp 90815 <br /> 1 53 All well material was drilled out to a de th of 55 <br /> feet below.grade.The hole was then tremie Addrei. 1,313 Charter Wav �I <br /> routed to a depth of 1 feet with clean a IAl City st6'kton _Co kitty San Joaquin <br /> cement.Top of well was covered with soil to Latitudes "N L=angliudb Mm N <br /> match existing surface. Deo. Mn. sec <br /> Datum Decimal Lat Decimal;kong <br /> APN 8 ok 151 PAge arcel .0 <br /> TownsI a on <br /> 1111 <br /> NdW Well <br /> Q MOdikcationlRepair <br /> Q Deepen <br /> i. <br /> O Other <br /> Destroy <br /> oe.�,roe pawdu�a.�d mmerlNs <br /> uider'GEOLOGIG lAe'. <br /> O Water Supoly <br /> ODomestic ❑Public <br /> 6 oliTigation: ❑Industrial <br /> -Ilk <br /> Vin= Q Cathodic Protection <br /> Q Dewatering <br /> T 1 O Heat Exchange <br /> 1`a O injection <br /> O Monitoring <br /> .0 Remediation <br /> Q Spangling <br /> & Q Test Well <br /> Q Vapor Extraction <br /> ••�: - e�.a�a�,m arm r <br /> "dvaa,eta, dattAahsmep.ll�a ad�llanel PRR M neommy. Q Other. <br /> - plesr bs wed <br /> Depth o first water (Feet below surface) <br /> llepth o Static <br /> Water Laval (Feet) Date Measured <br /> TO tat Depth of Boling Feet Estim ted Yield• (GPM) Test Type <br /> f Completed Well 55 Feet T `rest L ngth (Flours) Total Drewdown�_(Feet) <br /> Total Depth o <br /> •Ma of be reresentathre of a well's long term yield. <br /> Rig <br /> Drrpth from rehole ,' Y� Material Thickness Diameter Screen <br /> SIat H Anya Surfacth e Fill Fill Description <br /> Surface <br /> 6ilatria r" <br /> Feet to Feet Inde-' Inches Inches (inches) Feet to Feet <br /> �.0.. <br /> . I <br /> Geologic Log 1,the undersigned,certify that this rep rt Is complete and accurate to the best of my knowtedge and belief <br /> 13Well Construction Diagram Name <br /> Perion,Flan or Carporetion <br /> ❑Geophysical Log(s) 19§1 Meeker A n Richmond �$ 94804 <br /> ❑SoillWater Chemical Analyses address � 8123111. tQW28� Lu <br /> Q Other Signed . <br /> Li <br /> Anaeraddell mrana,n n C•87 censed avatar VMI Contras Date 5i Signed C-57 License Number <br /> DWR 188 REV.t120DS IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMI3FRED FORM <br />