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rho fine Adobe Reader mey be umd to,lee opo u'f a miC farm, HVeever,eof ear now be purarowd to Complete,r! nd rues a mvAJ form <br /> Re Original vAlh DIM State of catlfomla DWR Use O -Do Not FO In <br /> Page 1 of 1 Well Completion Report <br /> /rcmrfe mmwnon Patagium =APN�Sfmff <br /> well <br /> Owner's Well Numbs MWO-2 No- e0107559 <br /> irate Work Regan 0211012010 Date Work Ended Q030_. LatitLmlll Permit Agency jaVLkadujp(,0UatYELWMaM9 njal Fr aim Dept Permit Number SR59394 Permit Date 2/12/10 <br /> . ..C3eolo is Lo - Well Owner <br /> Orfentatien OVertical VTI OAngla "patsy Nanta ,der Dhoof <br /> Duane Mclhvd Dfinna FIWtl ^— <br /> Depth from 8urfaen Descnpann Mailing Addreaa 156 n <br /> Foot mo •eat DesDlbD_mateUal,green .iso,color.ate C Slate CA zt »53.70 <br /> Well LOcatlon <br /> PmasuReMoVm grout with creat Cemami Addreas 1MG.South Harlan Road <br /> Remove vault bpx .': _.. Goy-Lamm ,_courtly sen Joadlan <br /> Remove upper 3 feet of well materials Latitude N Longitude_ �yy <br /> Patch ground surface ode. Mln. sea ro. um. So. <br /> Datum Decimal L8L Dedman!Long. <br /> APN Rook 196 Page Parcel 81 <br /> 7ownsh Ra a Section <br /> Location Sketch AerrAty <br /> kamrnuet ee drre hmm sMrfmuls row. New VJes <br /> Npnh O ModlficeOonfRepar <br /> 0 Deeper, <br /> O Other <br /> O Destroy <br /> erwmv Md MMetl. <br /> LOT <br /> Flamed Uees <br /> O Water Supply <br /> `` []Domestic ❑Public <br /> �d <br /> 01MIgation ❑mdusldal <br /> \ w O C9thtdic Prmxlion <br /> wn��� O Dewatedng <br /> MAdU 2 O Heat Exchange <br /> O In)cctlon <br /> O Monitoring <br /> O Remediation <br /> ...... O Sparging <br /> South O Teat!Nell <br /> ...„ e»pnr MeenmM earnnen,e..ndarrnMr.MfSn O Vapor edraction <br /> M. O Other <br /> wrnLnm MeeveMsm.p,urn ndmlamrwdraneerrnn. <br /> nromrMevme Mtl <br /> Nater Level and Weld Df Completed Well <br /> Depth 10 first water (Feet below surface) <br /> began to Static <br /> Water Level (Feel) Date Measured <br /> I Total Depth M Bering Feel Estimated Veld" (GPM) Teal Type <br /> 1 Test Len ) <br /> Total Depth elf Carmrleled Well 19 Feet not bac rapresentativa of a(well$)it=T term old m^-fFeet <br /> Casi is , - Annular Ma011121 <br /> Depth from Dorehore MaNprlel Nrnn OPtclae wren SlotsR Depth from <br /> 1 Surface Dremeter TW Thtckneoe Dimmer TAMP If Any aurfaee Fat OpsCdptlon <br /> Feet b Feel Inches (-rrdrev Inchestree Feet N amort <br /> N <br /> ' Attachments CeRitica6en Statement <br /> LJ Geologic Log - 1,the underai ned,certify that this report is complete and aecurata to me fres,of my knowledge and belef <br /> ❑Wes Conatruellon Diagram Name,fj rllllm Comoanv <br /> ❑Geo Pnrnm,rim urcorpemnan <br /> Physical Log(s) <br /> ❑SoiKfttcr Chemical Analyses Ess d t \ eiy die 05----6 <br /> rl "0 Other 5fte Plan "!goes'_ 63 '+q,0 802934 <br /> i. ardor, csr ucnmw alum Date I d G"7 LIlxnse Number <br /> �Iw In sae.14200a IF ADVITIDNA"FACE M NEFMn,USFwEV WMEL VF,ty NUrytaEgEpFpaht <br /> I <br /> f , <br /> I <br />