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*The free Adobe Reader may be used to view and complete this form. However,software must be purchased to complete,save,and reuse a saved form. <br /> File Original with DWR State of California DWR Use Onl —Do Not Fill In <br /> Page 31 of 42 Well Completion Report E=7 <br /> � —r— <br /> Rai Instruceon Panne,, 1 <br /> Owner's Well Number MW-20B No. e0162846 State Well Number/Site Number <br /> Date Work Began 09/24/2012 Date Work Ended 10/1/2012 --I- <br /> Local Permit Agency CvDnrt. Latitude N Lon i'tutle <br /> w <br /> Permit Number JNA Permit Dale APN/TRS/Other <br /> Geologic Log Well Owner <br /> Orientation OVertical 0Horizontal OAngle specify Name <br /> Drilling Method Hollow Stem Auger Drilling Fluid Bentonite mud <br /> Depth from 8UrfaceDescription 1,10.11n,Address <br /> Feet to Feet Describe material. rain size,color,etc Cil State zi <br /> 50 0 Overdrilled Well Location <br /> Address 6437 West Banner Street <br /> City Lodi County San Joaquin <br /> Latitude N Longitude <br /> Dee. Min. Sec. Deo Min Sec. w <br /> Datum Decimal Lat. Decimal Long. <br /> AF'N Book Page Parcel <br /> Township Range Section <br /> Location Sketch Activit <br /> liketci must be drawn by hand after corm is pirinledJ ONew Well <br /> North <br /> • O Modification/Repair <br /> O Deepen <br /> O Other <br /> - <br /> 0 Destroy <br /> Daecrlae weceeuree e.d irriii <br /> under GEOLOGIC LOG' <br /> Planned Uses <br /> O Water Supply <br /> ❑Domestic El Public <br /> ❑Irrigation ❑Industrial <br /> O Cathodic Protection <br /> 0 Dewatering <br /> O Heat Exchange <br /> 0 Injection <br /> 0 Monitoring <br /> Remediation <br /> 0 Sparging <br /> South O Test Well <br /> weer e,Oecme dere..or.,el rvmmme,emlempa re�e... 0 Vapor Extraction <br /> andalnch a men. use enddm�el oan=•�meaeee•v 0 ether <br /> Me.,I M ecwrab antl cam late. <br /> aler Level and Yield of Completed Well <br /> Del:th to first water (Feet below surface) <br /> Defth to Static <br /> Waler Level (Feet) Date Measured <br /> Total Depth of Boring 50 Feet Esti hated Yield• (GPM) Test Type <br /> Total Depth of Completed Well 50 Feet TeE Length (Hours) Total Drawdown_(Feet) <br /> 'Mal not be re resentative of a well's Iona term Yield. <br /> Casings Annular Material <br /> Depth from Borehole Wall Outside Screen Slot Size Depth from <br /> Surface Diameter Type Material Thickness Diameter Typi. If Any Surface Fill Description <br /> Feet to Feet Inches Inches Inches Inches Feet to Feet <br /> Attachments Certification Statement <br /> ❑ Geologic Log rAll <br /> d,certify that this report is complete and accurate to the best of my knowledge and belief <br /> ❑ Well Construction Diagram Abandonment <br /> Geophysical Log(s) .FirmorCorpoalmn <br /> rive Suite A , Sacramento CA 95826 <br /> Soil/Water Chemical AnalysesAstate rp <br /> 0 Other Site Mal) 10/23/2012 848359 <br /> Attach additional Informatof a it exists. ens pater Well Canuac or Date$I Ded C-57 License Number <br /> DWR 188 REV.12006 IF ADDITIONAL SPACE IS NEEDED,USE i CONSECUTIVELY NUMBERED FORM <br />