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LD <br /> 'The free Adobe Reader may be used to view and compteform. However,software must be purchased to complete,sad use a saved form, <br /> File Original with DWR State of California DWR Use Only-Do Not Fill In <br /> Page 4 of 12 Well Completion Report -- <br /> - Refer to rnsrrucr+on Aamphr=l State Well Number/Site Number <br /> Owner's Well Number MW-2 No. e0163020 <br /> Date Work Began 10122/2012 Date Work Ended 10/24/2012 — --�- L= <br /> .._., Latitude Lon nude <br /> Local Permit Agency-5AaJpaauin Emty Enyironmentgl Health DeQariment <br /> Permit Numbers Permit Date 1014112 APN/TRS/Otner <br /> Geologic Log Well Owner <br /> Orientation OVertical 0Horizontal OAngle specify Name Tarditi Rentals PTP <br /> Drilling Method Hollow Stem Au er Drilling Fluid Bentonite mud <br /> Depth 60th Surface Description Mailing Address 11396 N Hw.V 99 <br /> Feet to Feet Describe material,grain size,color,etc c.ily Lodi State—CA_Zip 95240 <br /> 80 10 Pressure Grout Well Location <br /> Address 11396 N. Highway 99 <br /> City Lodi County San Joaquin <br /> L,::titude N Longitude Tw <br /> Dec Min, Sec. Ded. Min. Sec. <br /> Datum Decimal Lat. Decimal Long, <br /> AI>N Book 459 Page 260 Parcel 10 <br /> Tl:,wnshi Range Section <br /> Location Sketch Activit <br /> (Sketch must be drawn by hand after form is piirted. r(DDestroy Well <br /> North ification/Repair <br /> eepen r <br /> ther <br /> ibe pocedures and'GEOLOGIC LOG' <br /> Planned Uses <br /> 0 Water Supply <br /> ❑Domestic ❑Public <br /> s' -� to ❑Irrigation ❑Industrial <br /> 0 Cathodic Protection <br /> 0 Dewatering <br /> 0 Heat Exchange <br /> Q Injection <br /> 0 Monitoring <br /> 0 Remediation <br /> 0 Sparging <br /> South 0 Test Well <br /> Rivet ate or describe distance of well hum rands,boildings.renes. 0 Vapor Extraction <br /> rive��,ale end attach a map,Use additional paper if necessary, 0 Other- <br /> Pleule 6e accurate end com late. <br /> titer Level and Yield of Com leted Well <br /> Depth to first water (Feet below surface) <br /> DE'Dth to Static <br /> Writer Level (Feet) Date Measured <br /> Total Depth of Boring 80 Feet Estimated Yield* (GPM) Test Type <br /> Total Depth of Completed Well 80 Feet Test Length (Hours) total Drawdown (Feet) <br /> Llvlay not be representative of a well's long term yield. <br /> Casings Annular Material <br /> Depth from Borehole Wall Outside Scnfen Slot Size Depth from <br /> Surface Diameter Type Material Thickness Diameter Tyl:e if Any Surface Fill Description <br /> Feet to Feet Inches Inches Inches Inches Feet to Feet <br /> Attachments.. _ _ Certification Statement 1 <br /> I <br /> ❑Geologic Log I,the undersigned,certify that this riaport is complete and accurate to the best of my knowledge and belief <br /> ❑Well Construction Diagram Name All Well Abandonment . <br /> Person,Firm or Corporation <br /> ❑Geophysical Log(s) 9245 Beatty Drive Suite„A ,— Sacramento CA 95826 <br /> ❑ Soil/Water Chemical Analyses Address - _�_�--� �- City State zip <br /> ED Other Site MaD Signed - �w :� 10/25/2012 848359 <br /> Attach additional infornavon if it exists- - Ocensed Wa[e�r Wel_ clor - Date Signed C-57 License Number <br /> DWR 188 REV.112OD6 IF ADDITIONAL SPACE IS NEEDED,USE NE;aTCONS ECUTiVELY NUMBERED FORM <br />