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yu f <br /> t.*Tno free Adobe Rounder may ae used to Mew and of �A Mi%lean-Heww <br /> er,wrMro pmusk W.purchased to complete,r� ,,,no name a eaves form, <br /> J�Pile OrlgInOl with DWR �� Slate of California p Uwpn -Do Not Flunk <br /> •'age 1 of + well Completion Report <br /> RpnrromaMmlba Paspma - saM VVcNI NuaWtt/&ars N.mbar <br /> Ovmer's vy,9li Number MW-5 Ne. 0107552 <br /> 'Date work Began 02116/2010 Date Work Ended 2119@010 I Lallardo I N LoL huda ` <br /> Local Ferrell Agenq cys�sl4i�fllllin C-oUnty Enylmngen,tel Hsalth f)t ( �� i 7 i I <br /> Permll Number .$,7.. Permit Date 211WIP - APNRRSIOther I <br /> . . ..Geologle Lo Well Owner <br /> Orientation OVerlical OHorizontal OAngle speelry Name D3Wngar Dhoot <br /> Ddlunp Method D MMOFluid <br /> Depth bore Surface: : Dnacr)ptlon Melling Address 16GD0 SoI�jFLHad�n Ria Imo. <br /> Forst to' of Deeaibo mmemal; mer etre calor.etc Lathrop State CA n <br /> Well Location <br /> Pressure wout whh neat cement Address 15000South.Harlan-Road <br /> Remove vault box - City LgHLiQp County son Joaquin <br /> Remove upper 3 feel at well materials Latitude N Lon <br /> geode <br /> Patch appund surface ann e`m, see Dna Mm. sss <br /> Datum Decimal LOL _ Declmal Long. <br /> APN Book 196 Page 200 Parcel 72 <br /> i <br /> Tomship Ran,ne Section <br /> 7 . Location Sketch Activity <br /> 4 rmiq badmm tmneallhrroen la New Well <br /> Noah Q MadificalionlRepah <br /> O Decpcn <br /> O Other <br /> Destroy <br /> oprra,vrxMsanrnmlmil.i•h <br /> Planned Uses <br /> I O water Supply <br /> EJDOmastic ❑Ribnc <br /> -. ffi w ❑imgarmn ❑lmustdal <br /> 3 vS r O Cethodla Protection <br /> gyp, O Detwtering <br /> Kit O Heat Exchange <br /> IVNAf-J 0Injection - <br /> l�fpUD I O MOMtodng <br /> — -- ri O ReMC48bon <br /> . O spar0ing <br /> South 0 Teat well <br /> nmm�mera miM mmnae x.edrmnmMahWlmm.saae., 0Vapof 6xb7dlon <br /> rsea.,ne.h.amrm ammo urs.ramwmsprmanmpasrar. O Ogler <br /> me.ree..apwroenaw ' <br /> Ell <br /> ler L:eval'and Yield ofGom blond WellDepth to first water (Feet below audace) <br /> Depth to starlitWaterLevel (PaeO DateMeaarand <br /> h of Boring peel Estimated YiHtl^ (GPM) Tess Type <br /> Depth of Completed Weg 20 Feel Test Length (Hours)Total Drawdown (Feet) <br /> `M act be R maeRlathre M a welre tens d. <br /> Casio s' : Annular Material <br /> Dopth R'am eemhola Type Material Niall Ouwde Scraen swseo, DOPM from <br /> Serfaee 110maw Thlcknem Monnoter Type If Any entrow Fie Description <br /> Feet to Feet sane) Onchesi OnchostIachus Fehk m Feel <br /> AtistchmenfsCodification Statement <br /> ❑Geologic Log 1,the underslRned,coolly that this report Is cornplete and accurate to the beat of my knov Lodge and beget <br /> ❑Wen Construction Diagram Name J3,5Uarilling Company <br /> Parma.FM1mmgptpmaAw <br /> ❑Geophysical Log(a) 220 North East S,� WD d nd ,CA 95776 <br /> El Soll/Witer Chemieal Analyses (1 —e, 7- -"-�X On �� smro aP <br /> ❑Other Sita Plan signed °v-k L* 6. 802,34 <br /> AaeM rmm aro I rt pawn Car inn mrwo,Conrmaor Daly Rhhod C-57 Lleenae Number <br /> ywn IN Rev.lenod IF ADO TICNAL RPACF,10 NMMO.USP,NFxT CONSEWT11MLY YmPERM FORM <br />