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' PKDo5 <br /> ORIGINAL STATE OF CALIFORNIAW N Y — NOT FI R <br /> File with DWR WELL COMPLETION REPORT 5 O <br /> Page_o(_. Rrfpr w 11111MIal111I 1"Hephlef STATE WELL NO.ISTATION N0. <br /> 0ves Well No. No. 2016163 ;l� ❑ I I i ❑ <br /> Work Began 1012104 , Ended LATITUDE LONGITUDE <br /> IAKal Permit Agm7cy7 4 San Joaquin Health Dent. <br /> 3 r R&OTHBR <br /> Permit No. O YI Pcrm(t Date P? <br /> V GEOLOGIC LOC WELL OWNER <br /> ORIENTATION (S.) X VERTICAL :HORIZOWAL _ANGLE _ISPECIFo Name Glen Robertson <br /> DEPTH FROM <br /> Ap1REIf1W mud rotary FLUID water MldlingAldress 25060 S. Banta Rd. <br /> SURFACE DESCRIPTION Tracy CA 95304 <br /> Fl. b Fl. DL'.Terlhc material,grain.FI:C,Talar,Ota. CITY STAIE ZIP <br /> H'E LO ATI N <br /> I 1 c d Address Tr080 S. an a d. <br /> City <br /> Ju I3b1 sand Connly San -1 <br /> 38 54 I clay APN Book250 Pnge vicei 001 <br /> 54 I' 2 sand Township Bongo—Section <br /> I65Ilay LatitntleI NORTH Longitude WEST <br /> CEO. I M. SEC. DEa. MN. I SEC. <br /> LOCATION SKETCH ,ACTIVITY (=) <br /> I NORTH L� NEW WELL <br /> 210 4q6I I MODIPICAPONIREPAIR <br /> 4.16 AAR : ITOAAPAe <br /> DIMIISpKIryI <br /> 41`15 5041 nd - ranks; _ DEBTROYB%,.'I <br /> 904 507: clay IWM,V,AM IC LOG-7 <br /> 507 <br /> LOG'7 <br /> . .PLANNED-USES(—I) <br /> I I wrR WPPLY <br /> _Oemnik PWHc <br /> I I Ini'v. IndP4Ml <br /> MONITORING <br /> LEST WELL <br /> I I CAIHONC PROTECTION <br /> HUT EXCHANGE <br /> • DIRECT PUSH <br /> INJECTION <br /> I VAPOR EvFMOTION <br /> $PARDWp <br /> 1 I SAH REMEDIATION <br /> lilmrm a Pr L4un(u DWnmr I f n'ellfmm PoMIh,tlulhllna. <br /> I I Fpnm,III...Hp.and'0001 a pM . M mhlammat rrm7A'rllf OTHER(WEGFY) <br /> emnunj.PLEASE RE ACCLAIM7PI L CO,NIPLAT& <br /> {PATER LEVEL k YIELD OF COMPLETED WELh <br /> I I <br /> DEPTH TO FIRST WATER_(FLJ BELOW SURFACE <br /> DEPTH OF$TART <br /> WATER LEVEL 1 D 2 IR.)E DATE MEASURED <br /> ESTIMATED YIELD' (GPM)L TEST TYPE <br /> TOTAL.DE1TH OF ROILING b30IFL'M) TEST LENGTH_(Hn.)TOTAL DRAWDOWN (Ft.) <br /> TOTAL.DEPTH OF COMPLETED WELL 520 (FEF,) I 'Alay nark nprerraturrive of n velli fort -imn Idd. <br /> DEPTH BORE CASING (S) pEpT}I ANNULAR MATERIAL <br /> FROM SURFACE HOLE TYPE = FROM SURFACE TYPE <br /> DIA. Id, <br /> MATERIALI INTERNAL CAUSE $LOT SIZE CE• BEN <br /> R. to FL IMCM,) DRADE DIAMETER OR WALL IF ANY MEHT TOMTE FILL FILTER PACK <br /> OIMnp THICKNESS I)rc I) FI. to FG (TVPFISIZE) <br /> 0 480 12 IX 1 11 PVC 6 SDR17 0 200 X <br /> I ' 1 <br /> I I <br /> I , <br /> - <br /> ATTACHMENTS(2�) CERTIFICATION STATEMENT <br /> _Gwbgb Log I,the undersigned,cenity that this report is comPleto and accurate to the beet DI my knowledge and Della(. <br /> 1. _ WIN]cmurucecnDiagram NAME Hennings Bros. Grilling Co. , In c. <br /> Goophyaical Loge) (PERSON,FIRM,OR CORPORAIION) DYPEO OR PRIMED) <br /> _ SaT/Wator Chemical Alalysa, 3525 Pelandale Ave. Modesto CA 95356 <br /> Other ADDIS On StAIE UP <br /> ATTACH ADDITIONAL WFONMATU XL ff ET EXISTS. p 9 9(1 R 1 <br /> WELL DRI EN iNOFIlED AEPRESEXIAI DATE SCNED C•S)UCEXf[pjet <br /> Own IM LIPS•. II•Hi IF ADDITIONAL SPACE IS NEEDED, USE NEXT CO SECUTIVELY N I <br /> ERED FORM <br />