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'The free Adobe Reader maybe used to view and complete this form. However,software must be p.rchased to complete,save,and reuse a saved form. <br /> File Original with DWR State of California DWR Use Only—Do Not Fill In <br /> Page 26 Of 42 <br /> Well Completion Report _ t�� i ; <br /> Refer to Instruction Pamphlet State Well Number/Site Number <br /> Owner's Well Number MW-13A No. e0162841 <br /> Date Work Began 09/24/2012 Date Work Ended 10/1/2012 LatitudeJ-- "-t"--t-Lon�,ituie <br /> Local Permit Agency San Joaouin County Environmental Health Department <br /> Permit Number NA Permit Date APN/TRS/Other <br /> Geologic Log Well Owner <br /> Orientation @Vertical @Horizontal OAngle Specify [!ling <br /> meDrilling Method Hallow Stem Au er Drilling Fluid Bentonite mudDepth from Surface Description Address <br /> Feet to Feet Describe material, rain size,color,etc State_Zi <br /> 25 0 Pressure Grout Well Location <br /> Address 6437 West Banner Street <br /> city Lodi County San Joaquin <br /> Latitude N Longitude <br /> Deo. Min. Sec. Deo. Min. Sec. <br /> Datum Decimal Lat. Decimal Long. <br /> APN Book Page Parcel <br /> Tov+nshi Range Section <br /> Location Sketch Activity <br /> :;ketch must be drawn by hand after form is entad. O New Well <br /> North 0 Modification/Repair <br /> O Deepen <br /> 0 Other <br /> — <br /> 0 Destroy <br /> oeevme pmcetma end mammals <br /> under'GEOLOGIC LOG' <br /> Planned Uses <br /> 0 Water Supply <br /> C � i� I ❑Domestic ❑Public <br /> w ❑Irrigation ❑Industrial <br /> 0 Cathodic Protection <br /> 0 Dewatering <br /> 0 Heat Exchange <br /> 0 Injection <br /> 0 Monitoring <br /> 0 Remediation <br /> 0 Sparging <br /> South 0 Test Well <br /> oio,toeto-meanmd ndbe mammeo.use a <br /> daoroamo.brldmn.renal. Vapor <br /> Extraction <br /> endmoov e wac ramand corn ;er.. na;veernnea.aarOther <br /> — <br /> Witter <br /> Level and Yield of Completed Well <br /> Depth to first water (Feel below surface) <br /> -- Depth to Static <br /> Waiter Level (Feet) Date Measured <br /> Total Depth of Boring 25 Feet Es'imated Yield` (GPM) Test Type <br /> Total Depth of Completed Well 25 Feet Teat Length (Hours) Total Drawdown_(Feet) <br /> Way not be representative of a well's long term yield. <br /> Casings Annular Material <br /> Depth from Borehole Type Material Wall Outside Scroen Slot Size Depth from <br /> y <br /> Surface Diameter Thickness Diameter Type If Any Surface Fill Description <br /> Feet to Feet Inches Inches Inches Inches Feet to Feet <br /> 2 1 1 1 1 1 U <br /> Attachments Certification Statement <br /> ❑ Geologic Log I,the undersigned,certify that this report is complete and accurate to the best of my knowledge and belief <br /> ❑ Well Construction Diagram Name All Well Abandonment <br /> Person,Fin w Corporation <br /> ❑ Geophysical Ldg(s) 9245 BeattyDrive uite A Sacramento CA 95826 <br /> ❑ SoiVWater Chemical Analyses A eG' - Slate zip <br /> ❑ Other Site Map Signed � — 10/23/2012 848359 <br /> Aeech additional infomraGon if it wasb. � 7Lit'snsed Weler Well Conaactor Date Signed C-57 License Number <br /> DWR 188 REV.112006 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />