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-T10 fine Ad0W Raadar moy be heed le waw and wfJ)m1e form. Ho...eer,eorRyern mwl ba pulcheved W complete,e€w. d roue.a erred form <br /> File Original with DAR State of Calgbmla - _- DVVR tide On -IMNm Fan <br /> Well Completion Report <br /> Page 1 of t R blAmuceem rmm hw 1 I I I <br /> Owner's VMI Number MW-14B No, e0707568 r��1--$rm��n-�arum re umEnr <br /> Date work Began 0211612010 �o work Ended 2!79!2010 uL.__I__ alb 1^ I Langldd �W� <br /> Local Permit Agency fan Joaduln rgWAy Envimnment8l Health Dept I I t I I I I 1 1 <br /> Permit Numbbr 9R 93.3 --� Pcrmlt Dale 2M2110 APnrr113/011w <br /> . . .. '. <br /> Geologic Lo '. Well owner F <br /> Orientation O Vertical O Horizohtal OArgi0 sPenay Name Da adnder[)hoot <br /> .Drain Mediad _ Drilling Fluid <br /> Depth from Surface Dddodpdon Melling Address 15QQ0 South.Hanan Road <br /> Feet ro Fee! ' "Describe malamAl' in etre;colon ole . City LathtaD SIofa_CA _mp i 95330 I <br /> Well Location <br /> Pressure groin with neat cement Address Chandra Way.,Meiafltof Lone Way IPtersoction <br /> Remove vault box city LathroQ""_ County San Joaquin <br /> Remove upper 3 feet of wall materials Latitude _ �_ N Longitude <br /> Patch ground surface Dao. nun. ser. rano MM Sot. <br /> Datum Decimal Let Decimal Long. <br /> APN Book Pagb Pemrd <br /> TOwns Ra a Section <br /> Location Sketch Acthfitv <br /> flMvhA rnuntmdladn nvndMNrlamro 0N Well <br /> North O ModlaCallonJRapalr <br /> O Deepen <br /> CC� O Othar <br /> O Destroy <br /> Planned Uses <br /> - - O Water supply <br /> []Domestic opublo <br /> ❑inigdtion ❑tndusslal <br /> O Catholic Prolemim <br /> Q Dewatering <br /> _ 0 Heat Ewhange <br /> O Injection " <br /> q �t✓-'y� la <br /> O Remd lala <br /> Fn <br /> +J O Sparging <br /> 9bulh O Test Wep <br /> auwNrmm.sm.dm.w�I�n mn ror4,IdMNLameq O lhper EFtremllan <br /> O Other <br /> ruv.ee. <br /> Water Lave)and Yield of Completed Well <br /> Depth to first water (Feet below surface) <br /> Depth to Static <br /> Water Level (Feel) Date Measured <br /> notal Depth of Boring Feet Esfdnluod Yield• (GPM) Test Type <br /> Total Depth of compiated llVep 37 Feet Teal Length (HbUnk)Total Orewdomm_(Feel) <br /> •M mol be re ommamlafi.e of a weirs lam term kid. <br /> 'Caeings Annular Material <br /> Depthaem acrahuleWAIT 0101,1E semen slutalar booth both <br /> ',sudata Olanuter Type Mnlnrral Thickness DlnmAtnr Typo If Arry sur@eo Fin omeriptian <br /> rmtt Fee flhmfl (It't"IInch" nchca rat w Peet <br /> Attachments - CaMcadon Statement . <br /> 0 Geologic Leg. 1,the u tle signed,coldy that l ds repon is Complete and accurate to the nest of dry khorwedge and belief <br /> .❑Well Construction Diagram Name Et51 td..RnC�lno em <br /> 9 . . Pmtea,nn CCt1=11 <br /> ❑Geophysical L09(s) NOD h a t a Woodland CAA 95776 <br /> ❑SollMt ter Chemical Anatyaes D cM�/I ,fit C sw Zip <br /> ❑+ Other Sita Plan Signet!'' 1,�L- �C, - �.7! 502334 <br /> Arleen mut dit nANa. C-,�Uranmewnwr wen cevnra•. Date Sind C-67 Lloenee Number <br /> ",no REV 1=0 IK ADOITICtML SPACE IS NEEDED,USE NEM CONSECUTNELY NUMEERED FORM Yf(1 <br /> L_ <br /> I <br />