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III 'Tho from Adobe Rmldor mar ba"od In Nem and ate this form. However,nmrNmn+mune ha pumh'nod to M-00-U.end rodeo a onverl form, <br /> File Original with DWR State of Callibmic DwR Idea oa -Da Not Fe rn <br /> Page 1 of Well Completion Report <br /> /7nArmbalrorlionlPmrtM1Mt STele weA NmmbnNSAO Num r <br /> n <br /> owerswe1l Narrlber MW-120 No. e0107563 N, w <br /> Date Wnik Began 021 61.01 D Data Werk Ended 2!19120.10 IInW-�� t"� L� <br /> Local Pernllt Agency & Ir�aD�dn n mtv- jfon�FIP,91th Dent I r I I t <br /> Permit Number 59334 permit Date 2112110 --- <br /> Geoloctic Loa Wall Owner <br /> Orientation Ovedical 0 Horizontal OAngle srftly Nape Dalwlnder Moot <br /> I Drllhnp Method DffDna Fhdd Maning Address 1560D South Harlan Road <br /> _ Depth fromSurtaen Description <br /> Feint W Font Dnerma rneterlal,grain$1W,calor.etc city -Lathrop Stale 95330 <br /> With Location <br /> Pressure grout.with neat cement Address 15550 SOutb Jadan Road <br /> Remove vault boxt t <br /> City ,9illfQR CronySan Joaquin„ <br /> Remove upper 3 feet of well materials Letitade N Longitude <br /> Patch Smund surface Dole Min sen Der. Mla. sen <br /> DAttan Decimal Let. Dechnal Long. <br /> APN Stroh 198 _ Page 190 Perrot 81 <br /> Tovmsfi IN102 Section <br /> Location Sketch Activity <br /> Mqi mol barinwn Held eAx farm is Naw Wan <br /> North O Mod fleallortMepair <br /> o Deepen <br /> T O Other <br /> O Daslmy <br /> sermmear...na cram. <br /> - mem anneme <br /> _ Planned Uses <br /> - d water Supply <br /> • []Domestic[_-]Public <br /> r ❑Inigalion I]Indus tial <br /> �`- O CRmotlle Protection <br /> X04 O Devallerhtg <br /> O Hae.1]orhanpe <br /> O In)Bdloo <br /> O Monitor” <br /> t <br /> O Remediation <br /> O Sparging <br /> -. Snum O Tmo Well <br /> im.ememanwe..a..a...a...n m,m nen.amlwm..gran., O vapor Extractor, <br /> ebw.,dr.mkmmra a.mm,drc•ddamAm�mrrareenror. Q Other <br /> e..ar.erunm. <br /> star Level and Yield of Completed Well <br /> Depm to Arst water (reef bdewetnbaee) <br /> --• Depth to Slatic <br /> water Level (Feel) Date Mamned <br /> Total Depth ofgorMg Feet F_,,llmated Yield (GPrM Tell Type <br /> { 4Total Depth ofCompleled Well 71 Feet Test Length (Hours)Total Draeudetin_(Feet) <br /> May not be repnesenlands of a woWs term yield. <br /> . , <br /> C119inO 1 .. Annular Materlel <br /> 1 Depth frwn Borehole Type Material well outafd0 somon slat Sire Depth from <br /> a."..aace olanneter- Thickness Diamntar Typo nArry surtax FDI lediderlirtion <br /> r-eel ro Poet IntMmA Inclift nches Inchne Feat N Feet <br /> .Attaohmente Certltfcatten Statement <br /> ©Geologic Log I,the Idndatsigned,earthy,that UNG report Is complete and aerNrale to the bed Of my Imowfecige and belief <br /> Wall Corlsbuclion Diagram Name R_$I OriIlinD_CDmoanv <br /> " ,FUm orGpmRdan <br /> l�Geophyelcal Logs) 220 o a Streak CA 95776 <br /> ❑SolalNaler Chemical Analyses c scan ap <br /> p Other Site Plan S;-qh;e n 80231 <br /> Avaehmaaronmlm aAanbll mina. C-a>uamna mows[]caimnea. Date Signed q- L1rx+nse Number <br /> tone?In REV.rgAme IF ADOITIONALSAAM r$NEEDED,USE NF.[T MMEClfr1VSLV NLIMPF,REOFORn <br />