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.The tree Adobe Reader maybe used io view and complete this form However,software must be purchased to complete save and reuse a saved farm; - File Original with f3WR State of California = - D ee 0 _^Da Not Flltlfn Well Completion Report Page 1 of 1 f?erertorasin&iionPamphlal _ :Slate- iNtim6erl51truurnh?±r' ,. i Owners Well Number MW-2R - No. e01107021 Date Work Began 0212512010 Date Work Ended 2/251 1 d Lo t1lr9B Local Permit Agency, � H - -- APNRRSft]ther Permit Number SRO 59329 Permit Date 2112110 -- -----. _ Geolo lc_Lo - _ _ -- 'Well Owner - - 06;ntation Overiical 0Horizontal OAngle Specify. i1'Name Continental Grain Co. Drilling Method Ontltng E_luid t -- -� - '.Mailing Address Aon Center 200E Rand DO Suite 400 Depth from Surface Description - Chicago IL 60601._- i Feet'-1 o_. Feet_ _., _Describe.material rain size color,etc- .. _I cit,, - Staler - - Pressure Grout Abandonment Procedure: _ :4 , "Y _ 1Nell Loi:abon_ Remove cover,insert ,.iremieI e,to well bottom Address 1805_Harbor: tr et - -_- _ urn neat c_e_ment• taut_{5 B, a4L94#bag_ b of 3 City_Stockton_ County San Joaquin T pe,IV Portland_Cernent), ispllacing water-out. I Latitude N Longitude '_of welluntil neat cement at surface,Pressunze } Deo, Min.,- Sec, Dep,- Min, Sec,;. NAD53 Decimal Let: 37.3 �' 488932 Decimal Lo 121.315 " _,..�;well at-25 PSt-for 5 minutes and-lisp off neat �� Datum t cement as needed-Cut off a podion of 2"_PVC t' APN Book Page j _ --= Parcel 14502005 -- Township- I 1 h Range Q East Section to be below grade allowing neat cementlo be oN - over the PVC as a mushroom cap.Remava inside i `L"ocation Sketch W_ Actly - Sketch must 6e drawn b.hand atter farm Is.rinled l ring=of manhole and cement to be flush with - Now ell NoRh__._. _--. Q Modification/Repair surrounding ashalt paved surface._ P. O Deepen . i - O other-- ...- .:.._-Y.W.-y. - - — i ' - 0 Destroy� Total Volume of Neat Cement=.20 Gallons t Pla n d�Usesta� __.Monitoring Well INW_2111nstalled 11109/2005 �� WtrSu J t a Domestic yEl Public e p Abandoned 02125120.10 []Irrigation ❑industrial , Cathodic Protection i . . _- - _�-..-�---• -- � - O Dewatering Heat Exchange O Injection O Monitoring _ -- . :O Remediation � - -. .. parging O T r i' est Well t • - .. ".. -- .... .._ __ _ .,i'$i :e o dvecntw a t �r n+eu room roaev,txa�rngs,krceQ, 0 Vapo Extraclion rats c i, - .. __.._. _ __. ._ - vent'ete.`antl atladiaml"rusGaddulnna3 aapn ii rzecessary.. iO Other abandoned 1. ater Level and Yield of Com feted-Well.. De th to first water - .•,(Feet below surface)' i p _ - - Depth to Static _. Ji Water Level _10_. - -.(Feet) Date Measured 0310512009_ Total Depth of Boring 28 Feet , e=stimated Yield' (GPM) Test Type, 'I Test Lengthy,(Hours!Total Drawdown (Feet) TFeet ;� otal Depth of Completed Well.28 -- __- *May not be representative ofa-woll's long term-yield- -- _ Casiri s = __ .. Annular MaW lal...._-- Depth from Borehole _ . Material wall Outside Screen StotSize 'Depth from li Surface Diameter TypeThickness Diameter Type if Any Surface Fill Description Feet to Feet - Inches --(Inches-= Inches Inches - Feet.to Foet Blank_ evc sin ao- 0:154 .2.,0 - 4_ -_. Cement -- j cement oyeFbent_. 828 8.3 _ screen _ PVC Sch.40 0.154 2.0 Misled slots 1 0.020 6 '28 Fitter Pack No 3.Lonestar t' - - ' E l til ' I _Certfflcatinn Statement - ,_4ttac6tnents __- -:_: i ..- - - - - - - 1]Geologic Log I the undersigned,certify that this report Is complete and accurate to the best of my knowleiige and-belief 11 Well Construction Diagram ;Name Tuan N u en PresidentPerson, t Geophysical Log(s) !.1238-Alice CorpSt:Suite oration © m or t - _ -----•,. ,.Woodland .. -: CA , _95276._ I ❑Soil/Water Chemical Analyses ledreda City State zro Sign Kat 906899 l ❑Other - Fltar3reiitarat7ntb�r:fa4ion; 6aid3i.. - :57Licsnsed�Va W nttactcr-- - - -_ f• - � -.- �ignqct C-57�l.Icense.Number_..._ :. DwR 100 REV..V2006 _ - - -- IF AUDI730NALSPACE(S EDED.,USENEXT 66N8ECUTIVELYNUMHFREU FORM" ---"- '• ;j { f