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l 1 <br /> "TheI.Adobe Roader moy be Used to AM and loll this form. M�r,sokwarto must be puttAmad rornmWMa,Sma reuaoo saved form. <br /> File Original With DWR State of California DWR Uw Ofily-Do Not Fill In <br /> Well Completion Report 1 of 1 Rrdnrfs lnamamn Pnnpstd �. I-- - t I I 1 <br /> i Owners VWg Number MW-159 NO- 011117557 Slate Wed!Ni] <br /> N—u�me-�w�I <br /> Dale Work Megan 02L 6/2010 Date lNork Ended 2/1 912 019 Lada L <br /> �ocol Penne Agency can Joanuin County ERdIOlDMIt'MRI Wealth beta <br /> Permit Number 3858333 Permit Date 2/12/10 - AFwTR310Ner <br /> I � <br /> GEDIo is Lo Well OWrler <br /> Orientation OVertical O Horizontal OAngls speray— Name pelwinder Dhaot <br /> Drilling Alwhud Dniiing Flold <br /> Mailing Add <br /> Depth.from Surface DescriptiAddress15BD0 Sol�4h Haden RoRd <br /> Pmt m Feel Davedbe ansterlel.R.Mjn slic color e10 cay LothroD --state-CA—zip, 95330 <br /> Wall Location <br /> I. Pressure gmut With neat cement Address 155840 Soulb Harlon Rand <br /> Remove vault box _ City Latin= County San Joaquin <br /> Remove upper 3 feel of well materials - Latitude , N Longitude^__W <br /> Patch ground Surface o.m. Mn. a^a. DnF, enn. enc <br /> i Datum Decimal Lat. Decimal Long. <br /> APN MnnkIRS` Page 1913 Parcel -9— <br /> Section. <br /> 2Section <br /> l Location Sketch Activi <br /> i. kmn welbedwn hendnMrlpmb 0Naw Wel) <br /> NOM Q Mb,1I1CnaerVRepair <br /> O Deepen <br /> O Other <br /> t 0 Destroy <br /> mrealteaanwaa MetelM <br /> I uMu 9E0.001CL00' <br /> l — Planned Uses <br /> -^ I O Watar Supply <br /> []pnmestm �PubkE <br /> L]IMgadon ❑Industrial <br /> er O Cathodic Protection <br /> O LxWate ing <br /> O Heat F„Fchange <br /> O Monho" <br /> O Remedlation <br /> O sparging <br /> South O TPnt WeP <br /> 0 Vapor 6dradbn <br /> _ rwm,gc.romw,n nun.We reegeMrewn nneee.wr. 0Other <br /> Miter Level and Yield of Completed Well <br /> - Depth to f1mt araler (Fact bclew alMace) <br /> _ Depm to Static <br /> Water LEVET (Feet) DaleMeasured <br /> Total Depth of Boring Feet Estimated Yield" (GPM) Teat Type <br /> Total Depth of Completed Wall 36.5 Feet Test Length (Hours)Total Orawdown_(Feel) <br /> -ma rot be re ntaiNe of a wells long lam teki. <br /> Casings Annular Material <br /> Depnf(Mm Diameter <br /> a - Wall Damete Seinen 81ot Siee Deptlleem <br /> SUTIs F Dk hdAl Typo Material Thickness Diameter Type IrAnynehos SarAM Pia Paeedptbn <br /> Feel to Feel mcntls - Inches (Inches) InehBB Foal In Fact <br /> f <br /> Attadnmants CoMf)cation Statameitd <br /> l O Geologic Log I,the undersiggheeluirlHy that IhiR(spent 19COmplEle and accurate to the best of my knovAecige and beilef <br /> ElWell Consbuction Diagram Name RSI brillinD Com 1 <br /> 0GeophysicalLo Is) _ Ft�eAaE^.FA norDapoaron <br /> ❑SollAvterChamicalAnnly9es Oh Fes Street <br /> la CSY .s�ero 95778 <br /> pip <br /> Ef Omw S Plan Si c' <br /> 802334 <br /> 6fte,owyeAg,moggjr,,m,1q, Date Signed C.57 License Number <br /> IN Rev.1CIMS IF ADDITIDNAL SPACE Ia MEMPIJ.VaF mEtTf hISECLMIIE.LY RDMaeRFD FORM <br />