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'The free Adobe Reader may:be used to view and complete chis form, However,software must be purchased to complete,save,and reuse a saved form.. <br /> File Original with DWR State of California <br /> Well Completion Report <br /> Page 1 of 1 Reterlb,Instruction Pamphlel Slate Well Numbel Number <br /> Owners Well Number No. e0107036 <br /> [Date Work Began 02/25/2010 Date Work Ended 2125/2010 <br /> Local Permit Agency.;San jQ2aujn4Qo,F-.HQ--- j <br /> Permit Number SW059336 Perm it Date 2/12110 -- <br /> Orientation OVedical 0 Horizontal OAnglo Specify---�-- Nal Continental—Grain Co. <br /> Drilling Method. Drilling Fluid. mailing?0�r�q�s-..Aori Center-.200-E.Randolgh.$uite 400- <br /> Depth from Surface Cgy-Chicago- IL <br /> Describe I,etc 60601 <br /> ...Feel._ I Feet Material-arain.size,cola <br /> Pressure -Li5cal <br /> _QroLrt Abandonment Procedure: <br /> Remo"cover,,inser1ji-el to well bottom. Address .1..a05-Harbor.StLee .ROW aloe Side-of$0 <br /> pump neat cernent.grout-(5-&gp1194#.,.bag mix of... city,Stockton-.. County San Joaquin <br /> T� Ce <br /> Ype IKPqrtiand_ lmeC,-ffis displacing water out- Laititud, . N Longitude <br /> Dea,, Vln, set., <br /> �6f'well until neat cern ce-Prossurize <br /> Deo, Min, Gem, <br /> cement is at s u rfa Datum l Decimal Lat.37-9486466 Decimal Long.-121.315ji <br /> Well-at25 PSI fom-Wivu-t6s andlop off-.ne <br /> AFN Book— Page ,.�,Parcel <br /> cc rn 6jit'as�ne&dba.-c-Lit�off..a..-pciftidn--df.f-',P-VC' <br /> T,,,sMip 1-North.-Range L.-EAE19— Section <br /> t6 bilelow gr�de,alll Aedt d6iii6fit t6 e-: <br /> at u <br /> over the PVC' -a rin'shiobrn dap.Rerriove entire Loctitidin ketch Activity <br /> al <br /> ox to surrounding rth.return grade 9 No <br /> j8l mire[be drawn by is rinsed, :fl°Nevi;Well. <br /> cemented well 6 0modificationiRepair <br /> re <br /> conditions area in arbor <br /> sol -H.. 0 Deepen <br /> shoulder alonq.N--.Sill 6f Harbor St). ------ 0 Other. <br /> Total Volume P-f Neat.0-e.ment 20..Gallons Destroy <br /> Planned Uses <br /> 0 water Supply <br /> Monitoring Well.MW75_lr)stalled 96 E]Domestic E]Public <br /> Abandoned.02/26120 V Ellirrigallon 01ndustral <br /> '0 Cathodic Protection <br /> 0 Dewatering <br /> 0 Heat Exchange <br /> 0 Injection <br /> 10 Monitoring <br /> 0 Rennediation <br /> 0 Spal- <br /> (j)Test Well <br /> r <br /> 0 Vapor Ext action <br /> 0 Other <br /> Water Level and <br /> Yield of CompIeted Well. <br /> (Depth to first water (Feet below surface) <br /> Depth to Static. <br /> WaterLevel (Feet) Date Measured-12/1.0/2LQ_8 . <br /> Estimated Yield Test Type. <br /> To i <br /> lal Depth of Boring 25 feet (GPM) <br /> — 'Test Length- =(Fll Total Drawdo w-A (Feet) <br /> Total Depth of Completed well,25 feet <br /> 'Ma not be 4'reserilative of.a-_w.ell's Ion g-term-yfield— <br /> _Annular Material_ <br /> IN Outi;lde <br /> Depthfir0rin Borehole 'Type: all Screen -WtSiz Depth from <br /> Surface Diameter Thickness Diameter Type if Any Surface Fill Description <br /> Feet lo.Feet.- (Inches Inches')=.X,l Inches) Feet_ Feet Cernegi. .cement over bent. <br /> : �.0 - <br /> 0:154 [5 <br /> Blar <br /> :5 25 screenFVC Sch.40 9.154 2;0 Milled slots- 0,020 Z Filter Pack —SRI Supreme No 8 <br /> L <br /> an statement <br /> _N06ftents ,best of my knowledge and b6lief <br /> Name Tuan NQ <br /> Geologlc Log 1,the undersigned, <br /> certify his repot Is complete and accurate to the <br /> '' ' <br /> ❑Well Construction Diagram P"-n-" CA . 11 <br /> ..95776 <br /> Geophysical Log(s) .123&Alice St,Lte'AQ...-- - Woodland�- . <br /> E3 SoilA(Vater Chemical Analyses qtly as, <br /> 0 other S lgn1 906899 <br /> '--Vate-gigned --C-57,1-icbrise-Number <br /> DWR 706 REV.112CO6 IFA�6bfflO'WA:PAISNEEDFDUSLNEifdOfi$'ECUTFVELY <br />