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i <br /> HENNINGS BROTHERS Fac209-565-1 '"' Rus 19 1006 liISlam P002/002 <br />, <br /> tte iree Adobe Reader may be uses to view and complete this form Hbw@ver,software must be pur(;hased to complete,Save,And reuse a saved form. <br /> File Or'ginal with DWR State of Californla !R:Lt9e OnI :=Do'Nol:.` 112. <br />! Pae of Well Completion Report t 1 r a <br /> 6 Rehr ra tnlmelipn piempniet Siete V,?*1M.mbouSity Humber <br /> Own&r's well Number No. e�OL:i ["��—Tr`T! yy <br /> Date Work Began 8-9-06 Date Work Endod 8-12,06 La"tune Lon itude <br /> Local Permit Agency San Joaquin Co. Env. Hea th D_e_partment <br /> Permit Number_ 47681 Permit Date 7-:91-06 4PN/TRSJOther <br /> Geologic LQ J <br /> Orientation Vertical 0 Horizontal OAngle Specify Name -- <br /> Cr,lting Method Drilling Fluid <br /> 33 560 MANTHFY RD. <br /> Depth from Suri2co bsseripli6n Mailing Adtlress 12 8 <br /> Feel to Feet Deserihe rnatvrial,graln s9ze Color,etc city L A ROP State C A zi 9 5 3 3 d <br /> opso1 <br /> :iNe}i octia�loin <br /> 3 9 C l a y AddressHE Y R . <br /> 9 12 Sand City LATHROP • county SAN_ MAQI1TN <br /> 12 <br /> 33 Clay w i t h Sand StreaksLatitude N-Longitude w <br /> 33 1 64 B l u e Cl ay Dao. K" $Pp D.O. <br /> 64 1 104 1 Brown Clay Datum Decima)Lat Decimal-Long.�_ <br /> 104 144 1 C l d y with Gravel Streak5 APN Book Page . Parcel <br /> 144 153 Sand rownahlp Ran a section <br /> 153 169 C 1 a 1LOeattlktch Ai;ltVtt <br /> 169 1 7 Sand Skeacri; 4a!lie pta'*51!, :�Stlr for.n'.�Y ntiC New Well <br /> Q Modification/Repair <br /> 178 201 C l d yO Deepen <br /> 201 213 C l a y with San . Streaks OOther <br /> 213 215 Sand 0 Destroy <br /> rWedta peaces.."a MaM•ra <br /> 215 221. Clay <br /> ctOtodic�o4 <br /> 1 237 Sand & Gravel <br /> 237 250 Cla with Gravel Stre WaterSupply <br /> �Domeatic ❑Public <br /> } m w ❑irrigation Dlndusirial <br /> t i <br /> 0 Cathodic Protection <br /> 0 Dewatenng <br /> { 0 Heat Exchange <br /> O lnjacGon <br /> 0 Monitoring <br /> Q Remediation <br /> O Sparging <br /> South O Test Well <br /> 110v.v.++.antedl;Wo.or.4ufrom Made.e,iioine.,t-6, 0 Vapor Eldraction <br /> , eq.nc and sUagn a mea.W-addY.+r1 POP*,a reoeawy. 0 Other <br /> PNsr.er.r�,�N aM rvm +aM. <br /> efar°Level :iid'Yietd:`` : om 'aett3if:Welt: <br /> Depth to Firsl water (Feet below surface) <br /> Depth to Static <br /> Weter Level (Feet) Date Measured <br /> Total Depth of Boring 250 Feet Estimated Yield' (GPM) Test Type <br /> Total Depth o1 Completed Well 240 Feet Test Length (Hours) Total Drawdown (Feet) <br /> 'May not be representadVe of a well's long term XieJd. <br /> 1 Casings �crrnrllai Materiral <br /> ' Depth from 86reholc Walt Dutside Screen slot Size Depth from <br /> Surface Diameter Type Materiel Thickne4o Diameter Type If Any Surface Fill Description <br /> Feet to Foot InChOS Inches Inches (inches) Feet to Favi <br /> 2201 14" J BLA14K PVC SDR17 8" 0 1 180 10. 3 S <br /> 22 40 14" PERI=. PVC SDR17 " SLUERY <br /> 180 250 #6 SA DIGRAVEI <br /> Attachments <br /> ❑Geologic Log I,the un th port' tQ ec uele to the s1 of my knowledge and belief <br /> D Well Construction Diagram Name �� � � ��• p 1 �+ <br /> ❑Geophysicat Log(O 3525 P r W5WMAVE .— MODE ca, 9 5 5 f <br /> ❑ So(IANater Chemical Analysescity sur vp <br /> ❑Other Signed Can. B-19-0 2 9 t_l R_ 1 3 <br /> naO odI itonal i�ferm tlon,K 11 ex,ate. C-57 Uoeneed Water Weil Conlrectu Date Signed C-S7 License Number <br /> DWR 168 REve 112006 IF ADOITIONAi 6PAGE 15 NEEDED.USE NEXT CONSECUTIVELY NUMpERED FORM <br />