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'The free Adobe Reader maybe used to view and complete this form. However.software must be pL rchased to complete,save,and reuse a saved form. <br /> File Original with DWR State of California DWR Use Only—Do Not FIII In <br /> Well Completion Report <br /> Page 16 Of 42 Refer to MSINction Pamphlet 7-1­ <br /> i�� —F7 <br /> State Well Number/Site Number <br /> Owner's Well Number MW-8B No. e0162831 �TI <br /> Date Work Began 09/24/2012 Date Work Ended 101112012 ._ � Latitude Longitude <br /> Local Permit Agency San Joauuin County Environmental Health D Dartment 71---7T I I III I <br /> Permit Number NA Permit Date APNiTRS/Other <br /> Geologic Log Well Owner <br /> Orientation OVertical 0Horizontal OAngle Specify Drilling Method Hollow Stem Auger Grilling Fluid Bentonite mud <br /> Depth from Surface Description Mailing Address <br /> Feet to Feet Describe material, rain size,color,etc [NaCid/ State �I <br /> 50 0 Overdrilled Well Location <br /> Address 6437 West Banner Street <br /> City Lodi County San Joaquin <br /> Latitude N Longitude <br /> Dec Mln. Sec. Dec. Min. Sec. <br /> Da':um Decimal Lat. Decimal Long. <br /> APN Book Page Parcel <br /> Township —Ran a Section <br /> Location Sketch Activit <br /> c ketch must be drawn by hand after form is pnmed. O New Well <br /> North O Modification/Repair <br /> O Deepen <br /> _ 0 Other <br /> Q Destroy <br /> e deri'G'GEOLOGIC <br /> LOna metedels <br /> wder'GEGLGGIC LOG' <br /> Planned Uses <br /> '1 I O Water Supply <br /> jQ:7T-/'A ❑Domestic []Public <br /> 3 <br /> AAA <br /> El Irrigation [Industrial <br /> O Cathodic Protection <br /> O Dewatering <br /> O Heat Exchange <br /> O Injection <br /> O Monitoring <br /> O Remediation <br /> O Sparging <br /> South O Test Well <br /> aumrate or bespnbe dl.f.nre cf wen uom rp.ds,bmimnw,fenpea. O Vapor Extraction <br /> efe and etlanM1 a mep.lMe add4anel pepenl neceasery. O Other <br /> PNaw Ea vccunK vnd com IHa. <br /> Water Level and Yield of Completed Well <br /> De Tth t0 first water (Feel below surface) <br /> Dei:th to Static <br /> Water Level (Feet) Date Measured <br /> Total Depth of Boiling 50 Feet Estimated Yield' (GPM) Test Type <br /> Total Depth of Completed Well 50 Feet Test Length (Hours) Total Drawdown_(Feet) <br /> :M-ay not be representative of a well's long term yield. <br /> Casings Annular Material <br /> Depth from Borehole Wall Outside Son an Slot Size Depth from <br /> Surface Diameter Type Material Thickness Diameter Tyl:a If Any Surface Fill Description <br /> Feel to Fast Inches Inches Inches Inches Feet to Feet <br /> Attachments Certification Statement <br /> ❑ Geologic Log I,the undersigned,certify that this I?port is complete and accurate to the best of my knowledge and belief <br /> ❑ Well Construction Diagram Name All Well Abandonment <br /> ❑ Geophysical LO a Person,Finn or Comofation <br /> Log(s) 9245 Beatty Drive Suite-*- Sacramento CA 95826 <br /> ❑ SoilfWater Chemical Analyses <br /> Stele Zip <br /> ❑O Other Site Mai) Signed _ - - 10/23/2012 848359 <br /> Attach additional infonnarcn If it exists. C+ 61ce1fsadWa,tlwar oyn Date Signed C-57 License Number <br /> DNR 188 REV 112006 IF ADDITIONAL SPACE IS NEEDED,USE NEI:T CONSECUTIVELY NUMBERED FORM <br />