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`The free Adobe Reader maybe used to view and aomptete this fomt. However,software must be purchased to compete,save,and reuse a saved form. <br /> 4 File Original with DWR State of California <br /> ! DWRUse on =Do Not FUIn <br /> Page 1 of 1 Well Completion Report <br /> Owner's Well Number tNW 4 Na e017 q egg Male wen Number/51te Number <br /> Date Work Began 0 4&/2012 Date Work Ended 8/2012 N W 31 <br /> Local Permit A ency San JDepartmentHealth laude UarLqllude <br /> Permit Number SR0064384 Permit Dale 2116/12 APNiTRafother <br /> Geolo le Lon Well Owner <br /> Orientation OVertical O H0r1z0hW OAngle Specify Name Shell Oil Products U5 <br /> DrIling Me!hod Honaw Stem er DORN Fluid <br /> Depth from Surface Description Mailing Addross 20945 South WUmIngton,Avenue <br /> Feet to Feet Deacrtbematerial rain size aft etc city Gama state.CA_ - �I 90870 <br /> 0 35 The monitoring was destroyed bX drilling out all Well Location <br /> well components including well casing,annular Address 111410-West Yosemite Avenue <br /> grout cement,bentonite seal and filter sand.The city-Manteca' County, San Joaquin <br /> remaining hole was tremae grouted with clean, Latitude N Longitude <br /> —Type 1111 cement grout.Top of the well Is not. Min. sea .Dep, arra sec• <br /> finished to match exisfin syrface. Datum Decimal LaL 37.797 Decimal Long.-121234 <br /> APN Book,219 Page..02 Parcel 432 <br /> Township Ran a Section <br /> Location Sketch Activitv <br /> (Sketch nivat be diawn by hand artarfrnn is pilriteo 0 New Wall <br /> NO* O ModlficabortrAepair <br /> O Deepen <br /> 0 Other p <br /> Destroy <br /> - , - is !M.,—�wme+ L n.w4ep,orad„as sadrm'erhds 3 <br /> OW <br /> . - —�u_ �• aww __ undsrYaEOLOOiCLOG f <br /> •M >� Planned uses <br /> O Water Supply <br /> ❑Domestic []Public ' <br /> I ZM6 : ❑Irrigation ©Industrial <br /> l ,Y u <br /> O Cathodic Protection <br /> O Dewatering <br /> O Heat Farchange <br /> I I 0 Injection 1 <br /> •" 0 Monitoring <br /> O Remediation <br /> Q Sparging <br /> South <br /> O Test Weil <br /> LNx7mlr ordawrma d'�Wneat wrdhom meds.WlMlrea.[encs, 0 Vapor Extraction f <br /> Mas,ais.and ataa,o map Ll+v+d�aaorral lapv7rraera,rtt O Other <br /> ater Level and Yield of Completed Well <br /> Depth tofirst water (Feet below surface) <br /> Depth to Static, <br /> Water Leve] (Feet) Date Measured -. <br /> Total Depth of Boring 35 Feet Estimated Yield" (GPM) Test Type <br /> Test Length (Hours)Total Drawdown - . (Feet) <br /> Total Depth of Gompleted Wog 35 Feet Way not be representative of a well's longterm yield. £ <br /> Casings AnnularMaterlal <br /> Depth from Borehole .I. Material Wall Outside Screen Slot$fie Depth from <br /> Di <br />! Surface ameter YPe Thickness Diameter Type If Any Surraaa FIA - Description <br /> Feet w Feat inches) Onchbal Uncher.) inches Feet to Feet <br /> i Attachments Certification Statement <br /> ❑Geologic Log I,the undersigned!Corti that this report is complete and accurate to the best of my knowledge and belief <br /> ❑Well Construction Diagram Name Greag[7nlIInQ TA$tlrld <br /> jPerson.Firm m Cordoretlan <br /> ©Geophysical Log(s) 950 Howe Road Maf#lnez CA: 94553 <br /> SONVaterChemical-Analyses' �� Zip <br /> I 1]Other Signed <br /> 885165 <br />! Anarh adYrflmal Irrforma n rt e�sb. �� Vvater'UY-Cada Date Signed C-57 License Number <br /> DNht t08 REV.1Ro08 - IF ADDITIONAL SPACE IS NEEUFO.VS'w NEXT CONSECUrIVFlYNUMEREDFORM <br /> I <br /> i <br />