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"The see Adoho Render nay be mod to uWw and w� �N Mia form. Meweuar,mfhrnm moat be pumheeN to conplate, Ilk nd 19use,a Saved form. <br /> File Original with DWR ,alp State of California uwR use rnuy_ootum Faun <br /> Well Completion Report <br /> age 1 of 9 wxmrrP ra9pxdpn ppmrmmr <br /> Stay, sue reverser 1 <br /> Dvrnors Well Number MW-14A _ No. aOIDT567I w <br /> ate Work Began 02/1612010 Date Worn Ended &19/2010 Lpawde Lon Sudo <br /> al Permit Agency 8arL.)Daedin�Qfdnty Ernlronmentai Health 4& F <br /> permit Numbor SR59335 Permit Dale 2112!10 ARNmtSMIW <br /> Geolo lc Log Wall Owner <br /> Orientation Ovedical 0Horinntal ' OAngle SP8* Name, Dalwinderohool d <br /> Ddang Method Oaflxm Filxd <br /> Depth from Surface Deacription Mal"Address 1560D So Halla R _ <br /> Feet to F4m dawrvA mnlerlxl,waln sam color,ate City LathropSlate OA 95380 <br /> I <br /> Wall Location <br /> Pressure nrout with neat cement AddressChandra ay.75'east of Lg1tL�Wav intemgion. <br /> Remove vault box city Wthrop County San Joat"n <br /> Remove upper 3 feet of well materials Latitude N Longitude—5;;-- <br /> Patch <br /> JN <br /> Patch round surface ow W. SiZ Dae Mm. sx <br /> Datum Decimal Lat. Optimal Long. <br /> - APN Dock Pagc Pa cal <br /> TownshiD —Rancre Section <br /> Location Sketch Actly <br /> ahekhnnalaedman Mild Blrorfamla ed. ()NBw Wwg <br /> ^— North O Modification/Repair <br /> O Deepen <br /> O Other <br /> �+ p Destroy <br /> wmaearrmannaMnnNmer <br /> uMn QEeI„OOICIeP <br /> _...,. _- PWmned Uses <br /> ° O Water Supply <br /> ... ❑Domesuc ❑Pubfic <br /> 16 ❑Irrlgellwn [Industrial <br /> lows O Cathodic Protection <br /> O Daumtadng <br /> O Neel Exchange <br /> 0 InjP.cllon <br /> IIA <br /> IQ O mwiteng <br /> O Remediation <br /> Q SpargIm <br /> South O Test WDII <br /> Mpm�n m"lora•Awpw m..a nxxrnM,Foaamr.M..... O vapor FXtractim <br /> n....,«r_mn.menamap.r,..eq„„�+wr..xroamMn OOther <br /> Water Level and Yield of CO pried Well <br /> Depth to first water (r-eet belowsurfacc) <br /> Depth to Stade <br /> water Level (Feeo bate Measured <br /> Total Depttl of Swing Feet Estimated Yletd" (GPW Teat Type <br /> Total Depth of Completed Well 15.5 FeM lest Length (Wears)Total DlawdarNru_(Feet) <br /> •M nat be enlative of a weirs long term leld. <br /> Cast s Annular Material <br /> Depth from Borehole n MandSr Watr Outelde Semen Sim SRa oPpta Hem <br /> Surraea Diurootor Thielempo Mead ar Too itAny alnfxCe Fin Deecdpwon <br /> Feet To Feet Onefteni (Incr,eft) Irlehds) (Inchesi real to Feet <br /> Attachments Certification Statement <br /> ©Geologic Log1,1110 underalf�Pd.certify that this tel wn IS complete and accurate to Uro beat of my Oov&dge and bHlef <br /> ©Well Construction Dia gram Name R51.0[Ilgna-Company <br /> Paned Ff ml ar CemNatlen <br /> ❑Sall/WGeophlorCsical Logia) 0 3 e waodlaad "M X5776 <br /> ❑Sog/Water Chemical Analyses � rAy sero zIe <br /> ❑Other Site Plan Signed �� L 7-'/P 802334 <br /> nlaeh edmlroml nro xrlMr ear�� vv"Sx Nud Date 3 med 0,57 Licergc Number <br /> tae Rev.I=% IF ADDITIONAL SPACE IS NEEDED,USE NExr CONSECUTNELY NUMBERED FORM <br /> I <br /> I <br /> r <br /> 1 <br />