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"The free Adobe Reader may be used to view and complex form. However,software must be purchased to complete,sad reuse a saved form. <br /> File Original with DWR <br /> State of California <br /> Page 2 of 12 Well Completion Report - --- <br /> DWR Use Onl -Do Not Fill In <br /> Owners Well Number VEW-1 Refer to Instruction Pamphr;f <br /> No. e0163017 State Well Number/Site Number <br /> Date Work Began 10/22/2012 Date Work Ended x(2412012 <br /> Local Permit AgencySan j de Lon nude <br /> I D Latitu <br /> Permit Number Permit Date 1014112 APNITRS/Other <br /> Orientation OVertii Geolb id Lo <br /> britlirs Method Hollow Stem al O Horizontal OAngle Specify Well Owner <br /> s AUCIerName Tarditi Rentals PTP <br /> Drilling Fluid Bentonite mud <br /> DepthTrom Surface Description Mailing Address 11396 N HwV,99 <br /> Feet to Feet , Describe material, rain size,color,etc Cit Lodi State CA �i 95240 <br /> 60 0 Overdrill <br /> Well Location _ <br /> Address 11396 N. Highway 99 <br /> Cray Lodi County an Joaquin <br /> Latitude N Longitude w <br /> Deo. Min. Sec. Deq. Min. 'Sec. <br /> D:tum Decimal Lat. Decimal Long. <br /> APN Book-059 _ Page 2fQ- Parcel 10 <br /> Tawnsh! Ran a Section <br /> Location Sketch Activi <br /> _G3ketch must be drawn bY hand after form is rirted, O New Well <br /> North 0 Modification/Repair <br /> O Deepen <br /> 0 Other— <br /> Destroy <br /> Describe procedures and materials <br /> under'GLOLOGIC LOG' <br /> Planned Uses <br /> 0 Water Supply <br /> [:]Domestic ❑Public <br /> ❑irrigation ❑Industrial <br /> 0 Cathodic Protection <br /> 0 Dewatering <br /> 0 Heat Exchange <br /> 0 Injection <br /> 0 Monitoring <br /> 0 Remediation <br /> 0 Sparging <br /> South 0 Test.Well <br /> Must'tte or describe ftlance or well hom reads.buildings.fences. 0 Vapor Extraction <br /> riven:vlc and attach a map,Use additional paper u necessary. <br /> PlearO Other <br /> e be accurate end com let.. <br /> atter Level and Yield of Completed Well <br /> Depth to first water (Feet below surface) <br /> Depth to Static <br /> Waler Level (Feet) Date Measured <br /> Total Depth of Boring 60 Feet Est mated Yield' <br /> (GPM) Test Type <br /> Total Depth of'Completed Well 60 Teva Length <br /> Feet ^(Hours) Total Drawdown (Feet) <br /> ; not be repre of a welt's long term xield, <br /> Casings Annular Material <br /> Type Material f <br /> Depth from Borehole Annular Outside Screen Slot Size Depth from ff <br /> Surface Diameter 'Thickness Diameter T a <br /> Feet to Feet Inches Yt • if Any Surface Fill Description <br /> Inches Inches Inches Feet to Feet <br /> I <br /> Attachments <br /> Certification Statement <br /> ❑Geologic Log I,the undersigned,certify that this report is complete and accurate to the best of my knowledge and belief <br /> ❑Well Construction Diagram Name All Well Abandonment <br /> ❑ GeophysicalLog(s) Person,Firm orCorporali4n <br /> 9245 Beattv Drive Suite A c Lai-mento CA 95826 <br /> ©SoillWater Chemical Analyses Address : _ <br /> El Other Site Ma Signed -`��' �;:� -~� "�° Stale <br /> zip <br /> 10/25/2012 848359 <br /> Attach additionM irdormat#on it it exists. `C=57 License:6Warer Wel Contrector <br /> Date Signed <br /> DWR 188 REV.1!2006 C-57 License Number <br /> IF ADDITIONAL SPACE IS NEEDED,USE NENT CONSECUTIVELY NUMBERED FORM - <br /> 1 <br />