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t , I <br /> t'jTe tree ndoes Rmaer may be need to Naw nM cthis corm. Nexeaer,vabaale mut be purrnned W camplele.�qnd rouse a awed Ipith, <br /> ile Odglnrd Win DDDR State of Califomla UM Uee Only-Oa Not FRI In <br /> 45ago 1 ort Well Completion Report <br /> RO .M M..marron PempMPt stele Nkil Numeexs�le, ______yin _r. <br /> bwnar's Wei Nlanber MW-9 No. 0107562 =77 <br /> Date Wolk Began 0211 6)2010 Dale Work Ended WD&U10 Lelltbo9 Langkude <br /> Local Pertnit AgeIon <br /> 93 <br /> Agency A a in mN nvlmnmental Healtfl D�n1 r PNRRI <br /> Pormlt Ntmrber$RS34_ Permit Dale W2110 AS/Other <br /> . Geologic Lop 1 Well Owner <br /> Orientation OVenlcal 0Horizontal OAngle SPOT* Nam DBlWlnder Dhoot <br /> Ormina Method Ori ling Favid Maifrtg Addrow 15600 South Harlan Road <br /> Depth from surface Description Lathrop <br /> Feet to Feet Describe melertoA' min 91E0 cotar,etc Cf state jrA -71P95330 <br /> . . Well Location <br /> Pressure grout_With neat Cement Address 1§k40 Sot Herten Road <br /> -•••m Remove vault box - City Lathrop County Sen Joaquin <br /> Remove upper 3 feet of well materials Latitude N Longitude <br /> Patch ground surfaceDsa. Nae, see Deo. Min see. <br /> DUIUM Decinell LaL Decimal Long. <br /> APN Book 196 Page 190 Parcel a1 <br /> - - Towns Ran Section <br /> Location Sketch Activity <br /> hMen.9 be ereret b ever aftelftrre M ft New W21I <br /> North O MeditfeatitmlRopair <br /> O Deepen <br /> O Other <br /> . Q Destroy <br /> asaR.Peru eunnwlnr I` <br /> uMer VEOILCIe Ina' <br /> Planned Uses <br /> O Ureter supply <br /> []Domestk pPubllc <br /> ,�ti� � ❑Irylgallpn ❑Intlrmfrlal <br /> O Cathodic Protection <br /> - - O Dewatering <br /> O Heat Exchange <br /> O Injection <br /> 1 O Monitoring <br /> O Remediation <br /> O Sparging <br /> Bootie O Tam Well I <br /> m,.e..«er.exmm.rssam«.es.er..n,.rnm.e..r.,e.., O Vapor F.xuacaon <br /> rlwd,.Ie.MMMM seq,Wr dMI[mis.rdi nnw'�...rr. O Other <br /> plw MaeeaMa mtl <br /> ter Level and Yield of Completed Walt <br /> Depth 10 First water (Feet below surf rcal <br /> Depth to Static <br /> Water Level (Feet) Date Measured <br /> Total Depth of Boring Feel E9ltm2ted Yield (GPM) Test Type <br /> Total Depth of Completed Well 16 Feel Test Lartntn (Hours) Total Orawdown_(Feel) <br /> Mary not beresentaiw of a well's I m terH. <br /> s <br /> .. . . Cavin ` . . Annular Mnterfal <br /> Depth from Borehole Wall Outside sarwn Slotsize Depth Rwn <br /> sudow Mameeer TypoMnterlel Thkkwea Oleerieter TYPO if Any Surmoo FIB Description <br /> Feet h Feet nchca IArhee Inches n <br /> Itoe F•IMu ro Feet <br /> A1CdetlmelM9 - Certiftation Sentiment <br /> GeOlogle Lop I,the undersig9nned,certify than this report in complete and accurate to the best of my knaMedge and better <br /> 4 Well Construction Diagram Name'.RSI DDlllno CORIDany <br /> ml ofl <br /> Q Geophysical Log(l) 2 erMnmR stFiaerierCes ry"` �V I CA 96776 <br /> CISolMaterChemicalAnalyses ** csr Green zt <br /> O Other Sita PIS Signed. � E�,� � 1 Y ,*,b 502334 <br /> a rex a.ldb. GElucennxr ncannxror'11 Date Sl d C:71_lwlts6Number <br /> _ewe 10B ew IM00e 0'ADDITIONAL SPACE,19 W.E ,.tMK NF."CONMCMIWIY NUMBERED FORM 1 <br />