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I <br /> 'The free Adobe Reeder may be used to view and complete Is form. However,software must be purchat ed to complete,save,and reuse a saved form. <br /> File Original with DWR State of California r, <br /> Page 1 of Well Completion Report <br /> Reterto lnslnicllon Pamphlet Stale erI NumberlSke Number. f <br /> owner's Well Number MW-9 iso. e0135547 N w <br /> Date Work Began 06/20/2011 Date Work Ended 6/22/20" _ La4tude Longitude <br /> Local Permit Agency <br /> Permit Number 0062755 _ Pemtit Date 6113111 APNfrRSlOther <br /> r <br /> Orientation O Vertical O Horizontal OAngle Spedgi_ — Name hell Oil Products US <br /> Drilling Method Hollow Stem er Drilling Fluld Mailing ddress 20945 S Wilmington _ <br /> Ctty C rson State Chi 90815 <br /> 1 53 Well box and surroundingconcrete was removed MENEM <br /> A 20-inch:diameter hole was du around the Addre 1333 Charter W <br /> casingto a depth of 3 fb .Well was tremie City Gd C,6 n San Joaquin <br /> routed with dean cement and 25 psi of pressure Lefitud tt Lgitudd , e� w <br /> was applied for 10 minutes.The-casingwas then Deo. Mm. sec. MIn. <br /> Datum Decimal Ladr DedmaI16ng. <br /> cut to a depth of 2.5 flog.Grout was poured into.the,the hole to form a mushroom Ca t0 a depth of APN Bk 151 Page 37 "Parcel ; 07' <br /> ...,, ' <br /> 1 Tv of well was flnnished%%Wth concrete to owns-rip. Ra n <br /> match existing surface: <br /> NeW Well <br /> r h Q Modification/Repair <br /> •( .: O Deepen <br /> Q Other <br /> WA' Destroy <br /> . _ .. �, �'.' onarl6e p�dew and melalah <br /> '�roeo�acac we• <br /> 0 Water Supply <br /> ❑Domestic[]Public <br /> ' ❑Irrigation' ❑Industrial <br /> .0 Cathodic Protection <br /> O Dewatering <br /> 'a+ O Heat Exchange <br /> O injection <br /> ' 0 Monitoring: <br /> O Remodistion <br /> O Sparging <br /> O Test Well <br /> W So <br /> >Yr �.� .owe"im O Vapor action <br /> .. •-"=F'- Aran.efa alb m map.Use sdA6wW paper r neenwy. . <br /> Plena M .d O other <br /> Depth first water (Feet below surface) <br /> Depth o Static <br /> Water evel (Feet) Date Measured <br /> Total Depth of Boirig X53 <br /> Feet Estim ted Yleld (GPM) Test Type <br /> Total Depth tlf Completed Well 53s. Feet 'Test L ngth (Hours)Total Drawdowh (Feet) ! <br /> *May g of be representative of'a well's Iona term yield. <br /> Depth from -'Borehole Type Matarliil Well Outside Screen Slot size Depth from <br /> Surface OiBier Thickness.Diameter Type HAny 'Surface Fill Description <br /> Feet to Feel incl i Inches (Inches). inches Fest to Feet <br /> D Geologic Log I,the undersigned,certify that this report Is complete.end accurate to the best of my knowledge and belief <br /> 0 Well Construction Diagram Name _FZolorat• <br /> 0 Geophysical Log(s) 1961 Meeker•Ave =!on I' Richmond _ A 94804 <br /> 0 Soil/Water Chemical Analyses Addees cats state, zip <br /> 0 Other Signed 8123!11 283326 Attach tlonelllAamletlan lrnepdels: C-57 Ucensed Water Well r' Date S' ned C-57 License Number <br /> UM 188 REV.112006 IF ADDITIONAL SPACE IS NEEDED.USE NEXT NSECUTIVELY NUMBERED FORM ' <br />