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[t" "The free Adobe Readermay be used to view and complete thle form, However,saft"re in he purchased to complete,save,and revue a saved[Orn! <br /> File Original with DVVR State of California DWR use Only-Do Not Fdl to <br /> ??II rage 1 of I Well Completion Report <br /> ReferMfnatmeLor2Pamphfet- --. State WON Morn sartSlta Number .. <br /> Owner's Well Number MW-2 No.0014T601 N W <br /> Date Work Began 02!0512012 Date Work Ended 2/ Latitude Lon Rude <br /> Local Perrrlft Agency San A-Qa9jLh-E7unty Environmental F•61th De e <br /> Permit NumberSR0064M permit Date 2115112 APNlfRS/Mw <br /> Geolo ic'Ln Well Owner <br /> Orientation nVeAlca1 O Horizontal OAngle Specify Name 5_hell l Products US <br /> DfilgrkqDepth <br /> from <br /> SurfaHoflowce <br /> Stem Auger . p ting Fluid Maillrg Address 20945,Sguth Wilmington Avenue_ <br /> AFeett from Feet ae fest ription Carson CA �i 90810 <br /> Fee[ to Feet Descrr'6e materiel rain sire calor,etc C State <br /> 0 35 The monitoring well was destroyed by pressure Well Location <br /> grouting. Type i/lt Cement was used to grout the Address 1160 West Yosemite Avenue <br /> wolf and 25pst of pressure was applied for 10 min- City Manteca County San Joaquin <br /> utes.Top of the well was finished to match existing latitude �N Longitude ^yy <br /> surface. Dec: NIkL Sec. Dep. Min. sac <br /> A permit variance was obtained from SJCEHD to Datum _ Decimal Let: 37.797 Decimal Long.-121.234 <br /> pressure grout this well ' APN Book 219 Page 02 Parcel <br /> Township Range Secffan <br /> Location Sketch Activity <br /> .Skelchmust bedrepm byhoro after tern Is prinwd.l O hlewwell " <br /> North 0 ModificationlRepair <br /> 0 deepen <br /> ` »rarmnrreersart O other <br /> Destroy <br /> - �wnaa .I wi�,'a+nm rnde['6EOlaGIC LDe' <br /> 4. Planned Uses 3 <br /> f.. 0 Water Supply <br /> ODomestic❑Public <br /> .: —.. I <br /> ❑irrigation ❑Industrial <br /> O Cathodic ProtecWn <br /> O Dewatering i <br /> " f" O Heat Exchange <br /> �•;;. a,, O injection <br /> • i <br /> � T iMV+j�� Monitoring <br /> d O.Remediation <br /> 0 5par9ing I <br /> Sapth Test Well <br /> nvavatawdaf5e?�necmwdtirmnraadaeWdrta�saceq <br /> 0 vapor Extraction <br /> 0—i t w.taoh a maµtkrrsdjtfb }Paper a imawwr, 0 Other <br /> Aresse�-1q to Mdm,e eu <br /> ater Level and Yield of Completed Well <br /> Depth to first water (Feet below surface) € <br /> Depth to Static <br /> Water leve! (Feet) Date Measured <br /> Total Depth of Haring 35 Feet Estimated Yield' (GPM) Test Type. <br /> Total Depth of Completed well 35 Feet Test Length (Hours)Total Drawdown! (Feet) <br /> "Ma not be representative of a weirs ton term yield, <br /> Casio s Annular Material <br /> Depth from Borehole Walt Outside Screen Slot:';a Depth from <br /> Surface Diameter Type Material - ThteLnass Diameter Type !f Any Surface FI11 Description <br /> Feet to Feet Inches InchesEndres litchis Feet to f=eet <br /> r-T <br /> Attachments Certification Statement <br /> ©Geologic Log I,the undersigned,ce'U%that this report is completeand accurate to the best of my knowledge and belief <br /> ©Well Constrfaction Diagram Name GmQQ drilltnU$,Testing <br /> ❑ Persorn,Rim ofCarixm600 <br /> Geophysical Log(s) 950 Howe Road Martinez CA 94553 <br /> E�ScillWater Chemical Analyses - G �, s+aco zip <br /> 0 Other Signed - / 85165 <br /> `Aaaci•,uddaiow at ttItwdsfs- CGT waterwet1 mwxto Date S' ned C-67 License Number <br /> OWF?185 REV.IQODS IF ADDITMONAL SPACE IS NEEDED,USE NEKT CbNSECt}T1V_ELY M1MnERED I'mm <br /> I <br /> 1 <br />