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R <br /> Pe free Adobe Roedor may be uneo to Yaw and 4.,11Ie mis roan. Ho r,eeRwm Munk bn purdtesee M complew-Uwld reuse a caved rwnl; <br /> Sle Original with DWR State of California Dnam Ude on -De Net Fm M <br /> ago 7 of 1 Well Completion Report <br /> vmer'S Weg Number MW-7 Nm a reebeclbn RnnurSel statC vuca NumtxN Number <br /> _ Na. ¢0107554 <br /> Pate,Work Aagan 02/1612010 Date Work Ended 2/19/2070 urmne - Lan wds <br /> Local Pamlk Agenry San foam in{'ouMy Environmental Health Debt <br /> ,PermltNUrnbPr.ffi0%IL. Permit Dete 2112/10 APN/rRatDmar <br /> .GaolD lc'Co <br /> Well Owner <br /> Odentatlon OVernoel OHony 1 OAngto 5PacRy Nam Daiwind rrDhool <br /> Odning Method Ddnhlp Plead _ Melting Address 15600 South Haden Read <br /> Depth from Surface ... .. : >pescQpllon: Lathrop Feet m Feet' " Describe mahsdal In els Mmalc CI _ Stata CA. 7ip 95330 <br /> . <br /> Well Location <br /> Pressure grout with neat cement_ Address 1560D South Harlan Road <br /> "_ Remove vault box Cgy L ihmii County San Joaquin <br /> Remove Lipper 3 feet of well materials - Latitude N Lollgltudl, .W <br /> Patch ground surface - ose rtlu sea rnm. on. sec. <br /> Datum.Decimal Lal. oe00nel Long. <br /> APN Book 19_ Page 20Qpmaw 19 <br /> m...._-� Tawnshl Ranve Section <br /> Location Sketch Aaflvlt <br /> ...arch mwtoe¢Fawn nloner«rormm New Well <br /> Nd O ModHlcalionrRepair <br /> - Q Deepen <br /> -V .,�, I OOther <br /> OO Dealmy ` <br /> ______.•- Lt r a be. Leo, d. I <br /> �r <br /> -_ _-- -1 Planned Uses <br /> 1 O Water Supply <br /> L30omeetic ❑PubAc <br /> w ❑lntgadon ❑Industrlat <br /> l O cathodic Proteotinn <br /> O Dewatodng <br /> O Hest EXChortge <br /> 15fp0o . f O Injection <br /> ---� O M°r ltormg <br /> O Ramedlatlon <br /> O SPaMN <br /> South O Teri Wall <br /> Id,emnnMn....m.e ne.umae. .. OVapor Evradion <br /> dmr,pro,.mn MlM,smxn ve.amdnml titin n,rc<en.ry. O otter <br /> Pss»sasermm ms Id.. <br /> ater.Level•and Yield ofCompleted Wel) <br /> Depth to feet water (Feet below Swfsce) <br /> Depth to Static <br /> Water Level (Faeb Dav Mcesumd <br /> Total Depot of Owing Feet Estimated Yield^ (GPM) Teal Type <br /> Total Depth df Comph,ted Wall 19 Feet Test Lelfglh (Hours)Total Drawdoum_______(item <br /> *May not be r reserdMlve of a well's lortli farm 2M. <br /> Casin Annular Material <br /> Depth morn Borehole well orueide screen Not Size Deptif from <br /> Senses oft,"afnr Type Mdter181 Tmkknaea Dlameror Type If Any Surtxe Fm Description <br /> Fam to Feat fl0 %) (inch" Inches Inches Feet to Feet <br /> :Attachments Certiftestion Statement <br /> ❑Geologle Lag I,the urMamigned,cedl(y Ihot the repot Is complete Rntl accurate to me bell of my knowledge and belief <br /> Q Well Constmctlon Olagrem Name RSl Ddllino ComOgrJy„ '___. <br /> E3 alGmophyeRmmn,Flm w cm <br /> lcal Log(s) u?„0 et petlen o j y a6 <br /> 13SaillWeler Chomini AnatyBes Aaab+ Surf an <br /> ❑Dltier Site Plan Signed 602334 <br /> p. . .,al In c>>LNamn w{anrwnnGm�.er« Daf S ed CSI License Number <br /> PM Ise REV,1=0 IFADDITIONAL SPA F 15 NE MQ.USE NEXT COITSIM rWILY NUMBERED FORM <br /> k�k <br /> f <br />