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f J - <br /> I 'The free Adobe Reader may he used to Aew and tamplete th1s fore'However,aeilware must be purchased to complete,save,and ruse a saved form, <br /> 1 Fite Original with DVVR State of California SWR Usa Onl -Da laot FiU 1n <br /> Page 1 of 1 Well Completion Report <br /> Owners Well Number MW-1 orlo No.e0144759759 klsrr6 amphle: State tltrea IWum6er15ite Number - <br /> N � <br /> I Date Work Began 02!0512012 Date Work Ended.21 2t) -2 :: Latitude . Lo !code <br /> x Local Permit Agency SanJoaauin CQIt Environmental 1 E as ikh Department _ <br /> Permit Number S 78 Permlt Date 2193112 APNITRSIDiher <br /> GeDlo is LOQ Wall Owner <br /> Orientation OVertical O Horizontal OAngle spa Jail <br /> Ngme Shell Oil Products US <br /> Deptg Methofrom Hallow stem Auger Drilling FfuktMailing Address 20945 South Wilmington Avenue <br /> Depth from Surface Description ------ <br /> Feet to feet Describe material rain size color etOt C rya state CA 7? 99 18�_ <br /> 0 35 The monitoringinns destro ed b drillin Well Location <br /> well components fnduding well casing,annular Address 1160 West Yosemite Avenue <br /> grout cement,bentonite seal and filter sand.The Ctiy Manteca Cb,bty San Joaquin <br /> remaining hole was tremie grouted with clean <br /> Latitude N Longitude w <br /> ' Type Illi cement rout_Top of the well is ten.. ern. S 064 Mtn. sea <br /> finished to match existing surface. Datum Decimal Lat 37.797 Decimal Long.-121.234 <br /> AP.N Book 219:. Page 02 Parcel 033. <br /> Townshi Rana Section <br /> Location Sketch Activi <br /> - - alch m+mt ba warm by hand after corm Is"ted.) O NOW Weil F <br /> North Q MadiftaationlRepair <br /> O Deepen <br /> nesrrosserPrrmr OOther <br /> Q Destroy <br /> . ! �+m. ��—c""_� Deea@a procedYree end mak�4alai <br /> .....� , .; .. Planned Uses <br /> O Water Supply <br /> " ❑Domesbc❑Public <br /> raa:. .� r'1:• 1 i.: <br /> ❑irrigation ❑Industrial <br /> t :-.':1 O Cathodic Protection i <br /> ti'' <br /> Q Dewatering s <br /> O Beat Exchange <br /> ruwM v i ) F�—J [rr•..1 1 � O in action t <br /> r.. <br /> rte,: @ Monitoring <br /> 0 Remediation <br /> O spa4fflg <br /> soi,ktl O Test Wali <br /> O Vapor Extraction i <br /> . - IAwirata crtleacAtr dSdand erWslernnaOaCC,WaCi+as,hncw, <br /> drrrs,els.�d Whche—P.usea�dNt lPaper me .-Y. O Other <br /> _ pinna b��ewraw ami cam Wtw <br /> Water Level and Yield of Completed Well i <br /> Depth to first water (Feet below surface) <br /> Depth to static <br /> Water Levet (FeiQ Date Measured <br /> Total Depth of Baring 36 Feet Estimaled Yield" ' . (GPM) Test Type <br /> Total Depth of Completed well 35 Feet Test Length (Hours)Total Drawdown (Feet) <br /> *May not be representative of a well's long term yield. <br /> Casings Annular!Material <br /> Depth from Borehole wall outside Screen Slot 51ze t3epth from <br /> Surface diameter Type R6a�riai Thickness Diameter Type 11 Any Surface FIN- Description j <br /> Feet to Feat inches) Inches Inches Inches Fent to Feat 4 <br /> 1 <br /> Attachments Certification Statement <br /> ❑Geologic Log 1,the undersigned,certify that Ihis report Is.complete and accurate to the best of my knowledge and belief <br /> ❑Well Construction Diagram Name Greag Dr1111n4$Testing <br /> ❑Geophysical Logs) 950Howee=n 1r orCerpo .n z CA 94553 <br /> ❑Soil/Water Chemical Analyses a <br /> Cl Other Signed ✓ - �S 85155 <br /> i <br /> Altace aAdnhnal bite C - hare11 or <br /> . bate S ned C-57 License Number 1 <br /> DVN218a REv-112006 tF ADDIT)OiAL SPACE IS NEEDED,USE i;EM CONSECUI IVELY NUMBERED FORM <br /> t <br /> 1 i <br />