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/ i <br /> .•rho hee Adobe Readnr may be Used to vlow and con[�Ihlr feet Hawmror.aeltwal9 must IM purcmaBMte compkle,ea' 'rd rouse a sailed term. <br /> Fge Orlglnal vhth DVM State of Celtforrde DWR Use UII —Do Not Fal In <br /> nage 1 or 1 Well Completion Report <br /> Mauro rmmlal4n Faarms:r tele won Numberl5ae Nllm� <br /> fNme/s Wen Number MW-15A _ No, e0107556 IN <br /> Data Wolk Sagan gg"gU Date We*Ended 2Lj2jZQM- Lantude W wee <br /> 4ocal PemmT Agency SAJIJ OJEI ^"a pnv'ron en of Wgglth Deol <br /> permit NamUer j,;zB.L3��a as _ Permll Date 7112/10 A ru xs Deter <br /> —l0 IC'fi welt Owner <br /> Orientation Overlie"' OMarl2ontel OAngte specify Name DOW rMcr Dhool <br /> Drama Method Driaing Fluld Mating Address 15MOSOUthIM111117192110 <br /> '' 95330.. <br /> -. <br /> Depth, surface wesuilon ca-. ... !P . . . CII Lathrop -- <br /> Feet toFl<I D¢Yrlba mAleri5l min sae wbr cic <br /> - well Location <br /> Pressure grout with neat cement Address 355540-South HaEJM.Rggd� <br /> Remove Vault box City Lothr county San Joaquin <br /> Remove upper 3 feet of well materiels Latitude N I-ongaude <br /> Patch gWond Surface oeanils ssac. ams <br /> i Datum Decimal Let. Decimal Long. <br /> APN Soon-L4f2_._ Paga„19D parcel 82 <br /> 7owrLah Rene Secllon <br /> Location Sketch AOvitv <br /> j -- Ilalltum mown mmd amm�amro0 plea wen <br /> Nara+ Q ModlficatlonlRepaIr <br /> Q Deepen <br /> O Destroy <br /> xma Lan• <br /> I Planned Uses rl <br /> O Water Supply <br /> ❑Domestic ❑Public <br /> �4t0+IS�C L]hrlgatlon ❑mduahlal <br /> 6 I N <br /> O Cathodic ProterJion <br /> O DeaalaNrlg <br /> I O Wast Exchange <br /> 1 O Iryedon <br /> O Monitoring <br /> 0 Remecsetlon <br /> O Sparging <br /> '"- 9outry <br /> O Testwall <br /> mdmm+r,.dnuel,ormaal.•d L.M,Imm,nnNn,rr,en.o. O vapor ExtmGron <br /> . .. MnlllO.Fld tlbellaTlq.V+n WPor^•IOYllPonewrrrv. 001 <br /> _ _ neann.namlawde ma <br /> ater.LevarandYlaldoFCom IetedWell <br /> Depth b first water (Feel below surface) <br /> Depth to Static <br /> Water Lover (FeeO Delo Measured <br /> Toud Depth of 0orhtg Feet Estimated Yeld• (GPM) Test Type <br /> `Total Depth of Completed wen 17 Feet Test Length (Moura)Total Drewdo m_(Feel) <br /> Way,not be Mapresenlative of a aao's to form em. <br /> . . . . Casln s. . . . . .. . . Annularafiatedal <br /> Mom eam gemnole TPe MaWdnr wau -Llutelde semen eletaier. Depen/ram <br /> Surface DtOmetaf Tym; Dlametar Type If Any Sarrov. rill obecdplion <br /> Feet m FeN (Inches Inches ncnos ntllee Feel ro Feat <br /> 1 _ <br /> i <br /> Attachments: . . . :. ... . 'CertmcationStatement <br /> Ceologic Log - I,the undemiggnned,canlfy that INs report is complete end aaCurata to the test of my hnea4edgo and Deni <br /> Name �',I.6rllnno ComAerm <br /> ❑Well Conshuctton Dlagmm pen4n.rimrorempaedkn <br /> ❑Geophysical Logs) 220 No ^est <br /> ❑SotlAwatarChemical Anaysea signed -4)LOE04 SM334 <br /> E+ Other Mt`flan Gn/Llrann,�d t^�ell,rwalcmmmam Date Signed! C-57 Licanse NURlber <br /> nem 04411i 1 -450" n n Is <br /> .DMF in REV.12009 IC fiDbImONRI.?p/CE IS NF.M2b,USE KE =MEDUTNELY MMIMERED M" <br /> t <br />