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"Tho few.Adoio Reader mey Iro seed M Nnw and 4.11,te this rem. Hanev r,=fetors moat be girchnsod M WMPlele,umd reuse a Rued to=. <br /> File Original with DVVR Stale of California DWR uao pPIZ_DP Nm Fln In <br /> Well Completion Report J� I " <br /> r . ret r-IaRNh <br /> page <br /> t Permit AgenoYo�fC 11r09nn1 D_CnSIDIv_ ^, ._ Reeprrosrly.. _a,n_n�m_+n <br /> .�I I L <br /> me.ersLm N!.—m <br /> Owners Well Number W-a No. e107551 �.J.�14 10 <br /> DatOWOM60D1D Date Wank Ended 2210 � <br /> Parmlt Number SR59332 Permit Date 2!1nL.J <br /> ._ <br /> - I <br /> AawrRs+omer <br /> Geologic Log Well owner - <br /> Orientation O Vcrtlwl O Horizontal OAngle Bpaelfy Name Dalwinder DhoDt <br /> DrUllnp Method Dd11ns Fluid Malang Address 15600 South Hanan Read <br /> Depth Trom Surra= DascnimsenI athrop Scle A _ 95330 <br /> Feel ro Feet Oeulare mala ft,L k�mm.c ery em Cit <br /> I Well Location <br /> ' pressure grout with nest cement Address 15600 SOUM Harlan Road - <br /> Remove vault box city Lathron county Sen Joaquin <br /> i Remove upper 3 font of well materials latitudeN Longhude__ w <br /> Patch ground surface oea MIn. RuC Dm, Nm. ss'; <br /> - - Dalu n Decimal tat. Dedrltal Long. <br /> .... APN Book_?"_ Page 2O0 Porocl 79 -- <br /> Twins Ra section <br /> Location Sketch ActIvIty <br /> sxalm muneadrewn nerd mer manor New Well <br /> Nonh O Modi0w11adRepalr <br /> O Deepen <br /> 1 O Other <br /> O Destroy <br /> ar,dmr Mnmmnmr. <br /> Planned Used; <br /> . m. O Water supply <br /> [JDm estic ❑PutlAc <br /> ❑Irrlga&m ❑Itldustriel <br /> v o cathedle Protectfbn <br /> o Dawataring <br /> 1 y O Beat Exchange <br /> i IS6DD o lrr(edWn <br /> O Mamloring <br /> ^^'•— O Ramedlatlw <br /> i <br /> i .. O 9penpng <br /> Test well <br /> ninamn ar�armN,amen.l�rm...�«.enenwkmn, O Vapor Extraction <br /> rmra,.le.me marcnatnae rAnsArn.mla.r.r llanm.wr. 0 Other <br /> Water Level and Yield of Completed Well <br /> Depth to first water (Feet below surface) <br /> Depth to Slade <br /> j Water Level (Feet) Date Measured <br /> 1 [T-1 <br /> al DepB Buring Fee( Estimated yield (GPM Teat type <br /> .1 Depth of Completed well 20 Feet Test LeriMrr (Hours) Total Drawdown_(Feel) <br /> 'M not`be rosentaii"of a walla I term fold. <br />+ <br /> Casings Annular Material <br /> I Depth Rmn Borehole ryPa Mattered wall casu l M Screen Slat slay Depth Rose <br /> Surface Diameter ThIckmss Diameter Typa if Any Surface Fill Deetripdarr, <br /> Ford m Ferri Inclae Irrah") (Inch Inches Foot ro Pa1I <br /> I Attachments CertBication Statement <br /> ❑Geologic Log I.the underslggnnEd.certify the,Ihle report Is complete and accurate to the beet of my krmuledge and belief <br /> 0 Well Construction Diagram Name RSI DrillI iq Compaov <br /> Panan,Plml nr ComomrNm <br /> M Geophyelcid Logs) 220 Nmlh East St; Woodland CA 9$776 <br /> (. ❑SoWlaler Chemical Analyseseeraen cI � sem ZIP <br /> 0 Other Slta.Plan _ signed �8 _- _-- r r k W2334 <br /> AllG5>Ueansaawmmwnn camrmar 0819 sed 12.67 License Number <br /> DVA 11111 REV.1r a IF AWAIONA1.APACE 19 N DED,ME`46TCDNSECUTIVMY NUM5ERED FORM <br />