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} <br /> 'The free Adobe Readermay be used to view and compute this form. Floweve,SOINMe must be pwrhaaed to complete,save,and reuse a saved form. <br /> File Odglrtal with DWR State of Califomia DWR Use Only—Do Nat FA in <br /> Page 1 of 1 Well Completion Report <br /> RsFerto raafn n on PmrlµuCt <br /> � Owners Well Number MWti3 � No. ee147597 state wel�Numberlsfte Number w <br /> Date Work Began 02/0512012 Rate Work Fnded 21512D�7_- _ Laslhrde Lon !rude <br /> Logi Permit Agency Son Joaquin Cog rily' Environmenjul Heal pepartmer1j. <br /> Permit Number SR906 378 Permit Date 2115112 APNrrRs10ther <br /> Geolo le Log Well Owner <br /> Orientation OVertical d Horizontal OAngie Specify Name Shell bit l'raduc US <br /> Drilling Method Hollow Stem Auger Drlllkrg Fluid <br /> Depth from SurfacaDescrlptlon Mailing Address 20945 South Wilmington Avenue._ <br /> Feet to Feet Deacrlba malerial grain ft color,etc &'tiy QaWn State CA n 90810 <br /> D 35 The monitoring was desjEypd by drilltrig out all Well Location <br /> well components including well casing.annular Address 1160 W st Yase 'e ventre <br /> grout cement,bentonite seal and filter sand.The Cid Manteca county San Joaquin <br /> rernalnln hole was tremle grouted with clean Latitude N Longitude <br /> T e Ull cement grout.Top of the well is NIL r&,. sac. Dw. Min; Sam ' <br /> finished to match existing surface. Datum Decimal LaL 37.797 Decimal tang.-121.234 <br /> APN Back 219.,: . Page 02' Parcel 033 <br /> Townshl RanLe Section <br /> Location Sketch Activi <br /> etch mustbe draan by hard eilerfaan is pMWQd O Now well <br /> North <br /> O ModificakionlRepair f <br /> O Deepen <br /> „an,omrr.me',+E ' O Other ! <br /> �Fy� ^mom W Q Destroy } <br /> tr ,�,,,,�y.l— asdv^GEOLOolc ice• i <br /> Planned Uses <br /> O Water Supply I <br /> ❑Domestic©Public <br /> ❑Irrigation ❑lndustria3 <br /> O Cathodic Protection <br /> j„ f 'sem O Dewatering <br /> A j <br /> l O Heat Exchange <br /> O inJection <br /> • " O Monitoring <br /> I � ""�-: •�'•"{ O Remediation <br />' O Sparging <br /> South O Test Well <br /> q,ohab ardudb.darlairs arxap hem ro.�,h@rt rnp,frim, O Vapor Extraction <br /> dwm.dbaiCd�d,amaR Ljs m vanopviwirner vy O Other <br /> Please bo taw lata <br /> Water Level and Yield of Completed Well <br /> Depth to first water (Feet below surface) <br /> Depth to Static <br /> Water Level (Feet) Date Measured <br /> Total Depth of Baring 35 Feet Esbmated Yield* (GPM) Test Type <br /> Total Depth of Completed Well 35 Feet Test Length (Hours)Total Drawdown ^(Feet) <br /> Way not be representative of a well's long ter <br /> s Annular Materfal <br /> Depth from Borehale Type Marie! wall putslde Screen Scot Size Depth•from <br /> Surface Diameter yP Thtokne9s Diameter,` Type lfAny Surface Fte Vescrtptlan ' <br /> Feet to Feel Inches inches nrhes Inches Feet to Feet <br /> {t <br /> Attachments Certification Statement <br /> ©Geologic Log I,the undersigned certify that this report is oomplete and accurate to the best of my knowledge and belief <br /> 0 Well Construction Diagram Name G li $TPorBo <br /> rastin <br /> ©Geophysical Legs)) 950 Howe Road"Finn orca parivors rtinez CA' 94553 <br /> I]SoIIAVater Chemical Analyses -city. ptats zip <br /> 13 Other Signed . 51 E5 <br /> Attach rclditronal!r"Mil srs. d Water Cantraaar ©ate S tied "7 License Number <br /> MR 188 REV.1=6 IFADIDMONALSPACEISNEEDED,USE NEXT CONSECUTIVELY NUM9EREDFORM ' <br /> E <br />