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'The free Adobe Reader may be used to view and complete this form:However,software must be purchased to complele,save,and rause a saved form. File Original with DWR State of California 6 Use Onl -t]o Nat Fifth I: _+ Page 1 1 Well Completion Report or _.RefarfDlnstNdroaPampe elf NUnlber/Slte Number Owner's Well Number.MW 3 ::.. No. e0147443 .� f L StatetrJ.N i t' Bate Work Began 02N/20_1$ Date Work Endedh !201 Y f tdHtclde Lest tWde _- - Local Permit Agency J,52n JPaQuIn QTEHQ I " { , 'AP SiOther } ,permit Number SR#0059329- _ Permit Date 2112110 r,. Well Owner. Cs@oto Will - — Orientation O Vertical O Horiiontal OAngle Spocify,�T .I `Name Continental Grain Co. ! Dell th f om Surface t3escrl tion Mailing Address Aon,°Center 200;ERandolp_h:Suits 400 Drlllin F 4 ` - 1 p IL L 60601 i p CityChicago ---State_ • Feet 10 Feet._- – Describe material rainslze,color etc Overdrill AbandonmentProcedure: Well Location _ Overdrill to complete depth with,4.25"ID HSA.,- . Address 1805 Harbor Street(City–ROW along N.Side of Sit_._ _,Upon complete well destruction, lower tremie ,ty_5tockton_ _ County'San Joa din pipe to,bottom_of borehole.and pump neat cement Latitude. -'_ - , NLongttude _. rout,[mix ratio 5-6.gal.waterl94#bag of-Type IV ' oea•' Min:, sae: Dep run sec. batum NAM Decimal Lat.37.9487533 Decimal Long. 121.3 4 Portland)-Pum ,sealant to surface APN Book Page. Parcel 14502005 displaced roundwater for,disposaL Remove entire Township 1.North Ran a 6-East :Section cemented we 11 box excavate and_cut off 2".PVC a -..._ Location Sketch Achy below-grade,_top off.sealent to-create mushroom - Q New Well Sketchmualbedmonb,hard.efterfDimia rinted ; p g' ': _store round - .Norah-�- -�- � O Deepen � + I ca above sealed borehole and f2 g Q Modification/Repair I surface to surroundin soil conditions[unpaved) I -10 Other { l Sealant used=12 47#bags using,2 5 3,gallons �a r para k �Q'•D `. water/4 7#ba ;;total vol.of water=33 gallonst1 _.., ,. Planned Uses - Yvfu= ' Q WatersupplY Monitodfib Well,MW-3 Installed 08112!1998_ 1 s N ❑Domestic❑Public Abandoned 02124!2-010 ❑Irrigaiian I]industnal' a w .. ,. 0 Cathodic Protection f 0Dewatering _. J: _ - 0 Beat Exchange r I' - - , I 0 Injection 'k - -_ :- iO monitoring unit — - etmedia n Sar In — O pgg ►'o Extraction o .'; n Test Well _ 1,0 Vapor actt Yt _. - - - - - ' tluslrate ordaul6e defiance of rrelE€rom ready h�Wegs,fences, than.ap:;Use add0.�onal papsr-necze5 ry� IIQ Other abandoned - _-- ]ressii'ndfiainataimuwm - ater-L.evefand:Yield.ofCom Completed. _- Io d ace). - Depth to firsi water;13 _ '(Feet a ow su Depth to Static _ Water'Level 13 (Feet) Date Measured 12!10!2008 , Total Depth of Boring 2$ .. -. Feet 4 Estimated Y#elcl" (GPM) Test Type _ Total Depth of Completed Weli 28 Feet Test Length {Hours)Total Drawdown (Feet) _ "Ma _not,be_re resentative.of_a_well's.lon ,term.-le#d - ___Ciisings. A,nnular;Materlat. Dan.th from Borehole Type Material wall Outside Screen Slot Size' M601h from Surface Diameter Thickness Diameter Type if Any , Surface Fill Description ' Feet to Feet .. inches) (Inches .(Inches)-. (Inches)!, Feet ID Feet 0 8 $3 9[ank PVC SO.40 0.154 . :2:0 0 6_ cement cement over bent. 8 28 8:3 screen PVC Sch.aD 0.154. 2A ?Milled Slots fl.42Q 6 28 Filter SRI Supreme No$" _ - - 3 : , Attachments Certification StatementEl i ❑WellllICon traction Diagram ,Name:Tuapen�Ng 3v on,Preesidenteport is complele and accurate io the best of fray knowledge and belles ©Geophysical Log(s) 1238 Alice Sf.Suite.A. -... Woodland ..._. - CA. . 95776 . E ❑Soil/Water Chemical Analyses ddress °city scat. zip Other i Sign J .3 s� 906899 L€tens - er.walt Contractor _ _ _ ❑5 asmdrnd�itc+,ai�;rmmadon+�l�iiYf�+s: Date.S' ned C-57_LlcensE_Number _ DWR 186 REV,1=06 IFADDITIONALSPACE 1S NEEQFD,i15ENE%T C0kSECl7TlUELY RUMMREp FORM - yt t