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i <br /> 'The free_Kdobe Reader may be used to view and complete this form. However,software must be purchased to complete,save,and reuse a saved form. <br /> File?i iginal with DWR State of California s r'DVVR:Use Onl Oo Not FBI 1n+ <br /> Page of Well Completion Report <br /> Refer <br /> o. Instruction Pamphlet `��-u Ly„_Weil Number/ i N r <br /> ^"ner's Well Number No. 80151500 1/V:� <br /> Work Began 05/01/2012 Date Work Ended 5/3/2012 Latitude Lon itude <br /> t_ocai Permit Agency San Joaauin Co nvlronmental Health Dept. <br /> Permit Number 64830 Permit DateOth <br /> APN/TRS/ er <br /> a� R. �,�. s <br /> • F_ '�_r•�:.�e��s4s� _... . .. a �'."r x:�.et .r�f_. _.�Well�Owrier.xi.•.`:e.3.. �%`(°`;�?�;..>*.�:t't;.'.c,". <br /> Orientation (E)Vertical O Horizontal OAngle Specify <br /> Drilling Method mud rota Drilling Fluid Fresh Water <br /> r,tLtltlfOtRaSUtj8C8t �Vst,' zi .LG:^A•`r�eSG►IptlOfl ,�I. � �.fb �r`•a'`�`t`1" <br /> _iFbet�.iro..:sFeetx . :� ��.O .Oesrxtbe.materialrtrt�msiieeoloreto-::z .w:: l <br /> 0 2 to soil <br /> 2 12 clay Address 7300 Delta Rd cox <br /> 12 16 sand <br /> City TracyCounty San Joaquin <br /> 16 23 clay tom. <br /> Latitude ',QLongitude�'�'- <:';:•. w <br /> 23 155 1 sand oea Min. Se4? pea AA1i. Ssa <br /> 55 165 clay Datum Decimal Laity ,.Decimal-long. <br /> 65 170 sand APN Book,2]3 •Page 020µi' - Parcels 41..:. <br /> 70 115 clay Township Ran"e_ � *a Sectlon " <br /> 115 122 sand ,� :x h Asti , <br /> r"' � Locatlon?Sketch 'Y <br /> Sketrh ttiuist tlrawr%"'`haa ftefftirrn is - `of <br /> 122 140 clay North New Well <br /> 140 151 sand +„t, .- - <br /> 0 Modification/Repair <br /> 151 205 clayh ; `'' �D pen <br /> `0 Destroy <br /> _ ..:�,• u dw'G RauGIC LOG rn.ae:.b <br /> 'r'•, udar'eEOLOetC l06• <br /> 0 Water Supply <br /> Vis:- .:T• -; - '•u°: ❑Domestic ❑Public <br /> _. '- s. <br /> w ❑r Imgation ❑industrial <br /> 0 Cathodic Protection <br /> All <br /> 0 Dewatering <br /> 0 Heat Exchange <br /> 0Injection <br /> y, _+y3 ��=� '0` .�'t• ^4sfr •?,x.:9 0 Monitoring <br /> 0 Remediation <br /> z;r— parging <br /> South 0 Test Well <br /> 0 Vapor Extraction <br /> m,.tc..nd anal,a map.u ed,0 bn.l paper If nec.-,y. 0 Other <br /> At60,'Level and?Y161d Cornlil!Wd',WBU`..-"'.:� <br /> Depth to first water (Feet below surface) <br /> Depth to Static <br /> Water Level 15 (Feet) Date Measured <br /> Total Depth of Bdring r.205 �_ 4°,- Feet Estimated Yield' (GPM) Test Type <br /> Total Depth of Completed Well 155§s eFeet Test Length (Hours) Total Drawdown <br /> (Feet) <br /> May not be representative of a well's long term yield. <br /> - :^4<�'i A x..xc�t ti.� w jy�r�,��^ �+ ei Rp� *•»'�t^4 �s"��f"wi� c:i' 5 > � D... W �i x.-... .... <br /> ' °t, vt,:¢ .^� .L�:� =.X�V�In $"!?•- <._.._ ? _K r Y i .":y'�1 spa.fix., �,'�,�.A�nV1��;TY�,.N1h�.i%i7�,��u':,,'rti:�:i>:'•":':` <br /> Depth from Borehole Type Matsrlal MWall Outside Screen Slot Size Depth from <br /> Surface DInch0 sr. Thickness Diameter Type If Any Surface Fill Description <br /> Feet to Feet riches Inches Inches Inches Feet to Feet <br /> 0 115 114 blank PVC .332 8 0 60 quik grout <br /> 115 155 14 screen PVC .332 8 0.045 &0 155 6x8 sand pack <br /> Tir_k'�� x f+: Atfachmertts `to >.�w z MND A. ;, <br /> .... x' r t•��.. r �.r.+���ra . �...: ,�� .,..,.,'* �.Certlflcatlon$tat@ment :�...�rt., ... .�x�?'x`�•�. �.�.��;;z.=�;:;�:�• <br /> ❑Geologic Log I,the unt9ersloiled,certify thatithls report is complete and accurate to the best of my knowledge and belief <br /> ❑well Construction Diagram Name Hennings Bros. Drlllirlg.Co! Inc <br /> t t; Person,Flnn or Corporation <br /> ❑Geophysical Logs) 352 eli3ndale.Ave: Modesto CA 95356 <br /> ❑ Soil/Water Chemical Analyses Addresscity state zip <br /> ❑Other Signed ( 05/08/2012 290813 <br /> Attach additional information 8 it exists. C-57 L used water well tractor Date Signed C-57 License Number <br /> DVJR 188 REV.1/2006 IF ADDITIONAL SPAC NEEDED,USE NEXT CONSEC LY NUMBERED FORM <br />