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150 �S�(2 <br /> 'The tree Adobe Read4rmm ay be used t0 view and complete this form. However,sohwamust be purchased to morphine, ,and reuse a saved formRV (V <br /> File Original Stale of California DWR Use O _po Nor FII In <br /> Page 1 of 1 Well Completion Report <br /> Rearm/nahx9on varrproet Srate Well Nu <br /> Owners II Number MW-2 No. e0152242 � T mber/SBe Number <br /> Date Wo Began 02/27/2012 Date Work Ended 2/28/2012 LatitWe Lan dutle <br /> Local Per Agency <br /> Peril Numbe Permit Date 2/8/12 APWTRS/Other <br /> Geologic Log Well tDWner <br /> Orientation O Vertical O Horizontal OAngle Specify Name Ant Khinda <br /> Drilling Method 1­1011vw Stem A,ts, Drilling Fluid Mailing Address 1716 Kagehrio Drive <br /> Depth 6om Surface Description Mailing <br /> Tracy <br /> Feet n F Describe malarial rain ore State CA n 95376 <br /> 0 26 WELL DESTRUCTION:Overdrill 2"well Well Location <br /> from 0 to 26',backfill with cement. Address 16470 Cambridge Drive <br /> cry Lathrop County San Joaquin <br /> Latitude - N Longitude _W <br /> ec. Min. sec. kip Sec <br /> Daturl Decimal Later Decimal Long. <br /> APN Book 196 Page 4_ Parcel 032 <br /> Township —Range Section <br /> Location Sketch Activity <br /> sewn must bedraw,b hndetter form is plinjbd. New Well <br /> North <br /> O Modification/Repair <br /> O Deepen <br /> O Other <br /> O Destroy <br /> Planned Uses <br /> O Water Supply <br /> ❑Domestic ❑Public <br /> #' w <br /> [Irrigation ❑Industrial <br /> 0 Cathodic Protection <br /> O Dewatering <br /> O Heat Exchange <br /> O Injection <br /> 0 Monitoring <br /> 0 Remediation <br /> 0 Sparging <br /> Scud, 0 Test Well <br /> I.nw., 0 Vapor Extraction <br /> millw...e.o..n.,,�.p u...oa.o..i ni.,nre..:...r 0Other <br /> ...�......_ wa <br /> Water Levet and Yield of Comilileted Well <br /> Depth to first water (Feet below surface) <br /> Depth to Static <br /> Water Level (Feet) Date Measured <br /> Total Depth of Boring Feet Estimated Yield (GPM) Test Type <br /> Total Depth of Completed Well Feet ?est Length (Holl) Total Drawdown*Maynot be representative of a well's ion ter yield, —(Feet) <br /> If <br /> Any surface Fill Description <br /> Feet <br /> Casings Annular Matertal <br /> Depth horn Borehole Type Material Well Outside Screen SlSite Depth horn <br /> Suffice Diameter Thickness Diameter Type Im Feet Inches Inches Inches Inches Feet m Feet <br /> 0 26 Cement <br /> Attlachrnents Certification Statement <br /> ❑Geologic Log I,the undersigned,certify that this report is complete antl accurate to the best of my knowledge and belief <br /> ❑Well Construction Diagram Name WOC Exploration&Wells <br /> varson,Fkm or Con«alion <br /> ❑ Geophysical Logs) 9580 County Road 93B Zamora CA 95698 <br /> ❑SoiVWater Chemical Analyses Adana ,p Cay Saw rJp <br /> El Other SRe Map Signed . - .EX d..�— 5/18/12 283326 <br /> Anacn aomnonai nro�mabon.a a edea. O-a7 Licensed water,wall Contractor Date Signed C-57 Llcanse Number <br /> MR tae REV Maps IFADOITfOlA SPACE IS NEEDED,USE NEXTCONSECUTIVELY NUMBERED FORM <br /> 1111 V <br />