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bRIGINAL STATE OF CALIFORNIAw u ONLY — D MOT L <br /> rile with DWR WELL COMPLETION REPORT V��I..., I„ 1,2, i _I <br /> Page of Refer to lnrirnetion Pampblet STATE WELL N0.lStATION NO <br /> Owner%Well No 'No ��a� EJEJ <br /> Date Work Began 4, Ended J 8 LATITUDE LONGITUDE <br /> Loca)Permit Ae�cyO 5 3 u r n 1 Dept. <br /> Permit No. PeTmlt Date AP rTRS1 <br /> GEOLOGIC LOC "� AVELL OWNER <br /> ORIENTATION (2�) _VERTICAL w HORIZONTAL —ANGLE —(SPECIFY) Nflrile Jan n I s White <br /> DEPTH TO FIRST WATER (FL)AEI OW SURFACE Mailing Add,,,, 3 F,_ �V 9 6 <br /> SURFACE <br /> DESCRIPTION <br /> °S �� _,Stockton, , �Ca 95205 <br /> R�Ace =� <br /> Ft to FI Describe matenal,gram arse,color,etc � I-CkTY i iSTATE 2P <br /> t _ L.9 7 �f WELL OgATION <br /> Address �• � X - — <br /> WE BAD NN�ENT 4` ' `' 6ty� _Stockt ri <br /> c°Ilniy S �I,�, a u in <br /> 0 5 ' B ` J' ; APN BDok age Parcel <br /> Township Range Section <br /> abide� , , -NOImI Longitude I 1 WEST <br /> DS& MIN. SEC. DEO RUM SET'. <br /> LOCATION SXETCH AC'T'IVITY (f) <br /> NORTH NEW WELL <br /> MOWFIOATIDNlREPA1R <br /> _ 1 ^Deepen <br /> Other(SP00 ) <br /> x OESTROYMescdbe <br /> Proeadares arrdllrefearls <br /> I4rdar OrOLCGICLOG) <br /> f- PLANNED USES} <br /> t t MONITORING <br /> WATER SUFPLY <br /> — DamemNa <br /> t , <br /> Pulrllo <br /> IrrIgallao <br /> Ir,duelrlai <br /> t <br /> .—, 'TEST WELL <br /> CATHODIC PROTEC• <br /> F SOUTH TION <br /> F ' lldas(rate m Describe Dwfanm of Well fmm Landmarks —..OTHER(300CRY) <br /> much as Roads Saildings Fencez Ricers etc <br /> PI EASE BE ACCURATE& COMPLETE <br /> , r <br /> DRILLING <br /> METHOD FLUID <br /> WATER LEVEL a YIELD OF COMPLETED WELL <br /> DEPTH OF STATIO <br /> WATER LEVEL (Ft) d DATE MEASURED <br /> r r ESTIMATED YIELD' (GPM) & TEST TYPE <br /> TOTAL DErM OF BORING (Feet) TEST LENGTH (Hra.)TOTAL DRAWDOWN (Ft) <br /> TOTAL DEPTH OF COMPLETED WELL (Feet) "May wt be reprerentanwe of a well}Fong-term,Redd. <br /> DEiPTHCASINGS) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE BORE- T ✓ FROM SURFACE TYPE <br /> HOLTDIA o W MATERIAL/ INTERNAL GAUGE SLOT SIZE CE- BEM_ <br /> llnrhe� za GRADE DIAMETER OR WALL IF ANY ME:NT TONITE FILL FILTER PACK <br /> Ft to Ft (h,chsa) THICKNESS pachea) Ft to FI (TYPE/SIZE) <br /> ------------- <br /> r , <br /> I � ' <br /> , <br /> 'ATTACHMENTS CER'T'IFICATION STATEMENT <br /> LTeoloQEc Las L the undersigned.certify that this report Is complete and accurate to the best of my knowledge and belie( <br /> Well Construction Dlagrarm NAME.- D Edr.N T N G S BR 0 S, C RTLLING CO—e I N C <br /> (PERMN FIR?& OR CORPORATION) (TYPE,aft PRINTED) <br /> �., GeophyalcalLoU(a) <br /> SaRiwaterChemical Anatymm 352_5PELANDAC 8VE , __ MODESIO CA 953 <br /> RWRESS - CRY STATE IIP <br /> Outer <br /> ATTACH ACDITIOIVAL INFORMATIOA1 IF IT EmST3 BTgaed F ,m 1493 9 Ft 13 <br /> WELL DRILLS AUT 6RI2ED qE ESENTATIVE DATE SIGNED CC ST LCNNUMBER <br /> DWR105RFV 790 IF ADDITIONAL SPACE IS NEEDED USE NEXT CONSECUTIVELY NUMBERED FORM A3 <br />