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+-The fors Adobe Reader may be used to viewand y� ,i1a this form, HoWCVCr,SolMrere mune Oe pwcheeee 10 cemplMn, trod mune n nlryad/ohm. <br /> File Original WUh DWR V Slate of CRllfomiss OWR We O -De Not F01 In <br /> Page 1 of 1 . Well Completion Deport C <br /> ReM. fbn FamppMf I r <br /> Owners Well Number MW-11 No. e01 @111DD7566 1I��i state vues NumlmN&Ite Nameer ' <br /> Date Worn Began 02/15/201 Q Dote Work Ended x(2010— <br /> ��.J l_J._1J <br /> Local Permit Dent. I <br /> - <br /> onnb note 2112/10 Len,,,giwde i <br /> Permit Number 5R5 9335 p. <br /> APNRRBrOpaert <br /> Goold le,Lo . . •.. . Well Owner <br /> Orientation O Vertical O Horizontal OAngla specify _ Name palwmier phot <br /> Ddnirg uenrod Drlllllxr FMId <br /> Dopth from..Mote . .DRarrlptlon Mailing Address Al South Harlan Road _ <br /> Feet to Pell 011110 omeh9Ml malt adlor, ft City Lathrop oc�state M330. <br /> Well Lopation <br /> Pressure grout with neat cement <br /> Remove vault box •--• Address LPtlia WAV '((�Q'Soufhof ChanHr{h WAv Intek <br /> City LalhroD County San Juaddin <br /> Remove upper 3 feet of well materials Latitude — N LoWltude `---W---WPatch ground surface ro. mm, see oea._ al,,, ,ye<, <br /> Datum Decimal Lot.—Dedmal Long. <br /> APN Book Page parcel <br /> _ Tovms Ran a Section <br /> . .Location Sketch pctWi <br /> 3Nalenmua seerwn lemdeararonnu O New Wog <br /> ---�f•• Nath O Modiacallon/Repalr <br /> 0 Dee <br /> 0 Other_ <br /> ODeathly wewen.nen son. <br /> spa• <br /> ....- – ePlannedyJses <br /> O Water Soppy <br /> _ []Domestic []Public <br /> ❑1rigallon ❑Industrial <br /> LAS 91,1 Q Cathodic Pr blectlon <br /> O Oawalering <br /> O Heal Exchange <br /> 01n)ection <br /> O Monitoring <br /> O Remediation <br /> O Sponging <br /> 9oulh O Test Well <br /> . ANp,eleerennrm dmmepgwiuppm,mA,,pRnaae,recce, O Veber Extraction <br /> m«.,dw"ee mnsee mme.un awil",.eonene....ew. O DIX, <br /> n�..een„ alnee ro <br /> water Level and Yield of Completed Well <br /> oePth to flat water (Feet below surface) <br /> Depth to Snalip <br /> Water Level (Filer) D8le Measured <br /> Total Depth of Boring' FeetEstimated Yelcl (GPM) Test Type <br /> Total Depth of Completed Woe 15 Feet Test Length (Hours)Total Drawdown_(Fceg <br /> "M not be re smuatiw of a whits N rano old. <br /> Casld Annular ttllaterial <br /> Dap9a from aerehele Typo <br /> mabdal wen Ouln'do ecreen Stat 91xe onpth frour <br /> Surface diameter ylro Thickness Dimnater. Typo If Any Surface FM Dcecdptlon <br /> Ford la <br /> Fm Inches Illeh". tnchm nchea Feel to Fem <br /> Attechmefim CerdHcation Statement <br /> O Geologic Log 1,the uhdelsl hod,t rtiTy Ihat lhls report Is complete and accurate to the best of my knowledge and belief <br /> ❑We11 Construction Diagram Name RSI „nlmmoaroomnen <br /> ❑Geophysical Log(s) l 7aU811a <br /> �C�4 95776 <br /> ❑SogNVeter Chemical Analyses me <br /> 0 Other fit Pian Signed 1� t6 B 334 ZIP <br /> naeh conn(�dmmac NI,mm ,. ccr ueenseeWmorxha S nodC57 License Numbar <br /> PM toe Rev,trope IF ADDITtONALBPk(.'f:nJ NL+EDED,USF,NexTGON9FLUlNeLY NUo1ehRFD FORM <br /> f <br />