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r � l <br /> � 1 <br /> a "The tree Adobe Reader may be used to vlew and complete this form. However,sottvrare must be purctfas d to complete,save,and reuse a saved form. <br /> File Original with DWR Stale of California <br /> Page 1 Of Well Completion Report <br /> Rererfo lnstn"on Pamphlet State Well NumberlStle Number <br /> Owner's Well Number MW-8 N6. 0135546 e0135546 N w <br /> Date Work Began 06/20/2011 Date Work Ended fdQ2011 _ Latitude Longitude <br /> Local Permit Agency San Joaau in Eounty EnvirooMental Healab DeDartment El APNIFRslather <br /> Permit Number 0,062755 Permit Dale 6113111 I <br /> Orientation O Vertical. 0 Horizontal OAngle Spedry Name hell Oil Products US <br /> Drilling Method Hollow Stem er Drilling Fluid Mailing dress 20945 S Wilmington <br /> C G n State C, A �� 90815 <br /> 1 53 Well.box and surroundingconcrete was removed <br /> A 20-Inch diameter hole was du around the Address. <br /> casin to a depth of 3 fb .Well was tremie city S6 t ed&q San Joaquin <br /> grouted with clean cement and 25 psi of pressure Latitude tAengiSude <br /> was applied-for 10 minutes.The casih was then Dee. Min. sec flea. Min ��ec <br /> cut to a de th of 2.5 Grout was poured into.the Datum Decimal Lat. � Decimal tong <br /> the hole to form a.mushroom ca to a de th of APN Bo k J51 Page 37 Parcel ,007.". - III <br /> 1 fbg.Top of well was finnished.with concrete to Townsh Ran Y 5 .n <br /> match eI surface. . <br /> 0 Nd1N Well <br /> ` Q Momfication/Repair <br /> 0Dee,Fs> O Depen <br /> b. • Destroy <br /> oe.adne c aa. and me0.ifea <br /> rt wde•aeaLoGICcic tao <br /> y p <br /> 0 Water Supply <br /> ❑DomIPublic©inigation ❑Industrial <br /> 0 Cathodic Protectlon <br /> O.Dewatering <br /> ` w t 0 Heat Exchange <br /> .P�. 0 Injection. <br /> Monitoring <br /> C}Remediation <br /> 0 Sparging <br /> jk_ 0 Test Wsll <br /> of vM kmroods,bum".fence., <br /> 0 Vapor Extraction <br /> dve a,era. Mach.mss.use sdadu rveaer i neaeeeaY• .0 Other <br /> Depth o first water (Feet below surface) <br /> ' Deptti o Static <br /> Water eve! (Feet) Date Measured <br /> Total Depth of 060692 53 " Feet Estima Yield:" (GPM) Test Type -- <br /> Total Depth of Completed Well 5 Feet Test ngth (Hours) Total Drawdown_(Feet) <br /> *Ma t be re resentative of a well's la tens aM. <br /> Depth from holeYPe Ypaterfa� Wall outslde Screen Slot size Depth from <br /> Surface Thickness Diameter Type M Any- Surface RI! Description <br /> Feet to Feat 'ISetihbInches inches Inches Feetto Feet <br /> NEW <br /> ❑Geologic Log I,the undersigned,certlly that this reg rt is complete and accurate tdthe best of my knowledge and belief <br /> 0 Well Construction Diagram Name C <br /> fzWQE@1ion 8,Weill <br /> Person,Firm or Gorporaffon <br /> ©Geophysloal Lags) 1961 Meeker a RichmondPA . -94604 <br /> O Soil/Water Chemical Analyses Addre� atn�' stere ZJp <br /> 0 Other, _ Signed �� 8!23111 283326 <br /> Asad;adffortal Information.If 0 ftgffW. Gd7 Lbansed water Well Date-S ned .C-57 License Number - <br /> DWR 1138 REV,ItM IF ADDfTIONAL SPACE 13 NEEDED,USE NEXT SECUTIVELY NUMBERED FORM <br />