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ORIGINAL STkTE OF C YL[FOIIN t-1 DWR USE ONLY — DO NOT FILL IN <br /> File with DWR WELL COMPLETION REPORT <br /> �t <br /> P Lge�of 1 tic fr I f�� Illstr rfl ti�ril Pe1112rlllc t STATE WELL NO,STATION NO <br /> 01-'her s N eil -\o MW-9 �0 7 '5 4 003 l <br /> DdtC \\(ll l, 13t,-, r LATITUDE LONGITUDE <br /> u �� Ended t .��/3/ <br /> 1.(]L al Lal:l111Lt 1- lr0 HPNITKWU I HCH <br /> Peiintt No 0026237 Per ,,it Dite 5—1 - 0 1 <br /> GEOLOGIC LOC WELL OWNER <br /> ORIENTATION (�) ___,Z VERTKAL —HORIZONTAL —ANGLE —(SPECIFY) Name <br /> DRILLING m iling addressRiz 12130 <br /> DEPTH FROM METHOD FLUID <br /> SURFACE DESCRIPTION <br /> CA 94520 <br /> c sc r ILc utrul,acrl <br /> «Tac„ st_' Lal , tc clrY srarE ZIP <br /> Ft to Ft WELL LOCATION <br /> I <br /> �t -ddiess <br /> 3 Sj L Cit. Stockton <br /> c,,t,tV <br /> ( / " ,.PV Boos: Prge `1t —Parcel <br /> To«niship R rnge Section 7 <br /> I I <br /> Latitude I I NORTH LDlrgltilde f 1 WEST <br /> DEG MM SEG DEG MIN SEC <br /> LOC STION SKETCH ACTIVITI (z�) <br /> NORTH NEW NELL <br /> r I See attached Site plan. MODIFICATION/REPAIR <br /> — Deepen <br /> Other(Specrty) <br /> I I <br /> DESTROY(Describe <br /> Procedures and Malerais <br /> Under GEOLOGIC LOG ) <br /> I I PL- NED USES (.�L) <br /> WATER SUPPLY <br /> Domestic _.__, Public <br /> o I Irrigation __._ Inaustnal <br /> w w MONITOMNG— <br /> TEST WELL <br /> I I <br /> CATHODIC PROTECTION- <br /> ' HEAT EXCHANGE <br /> DIRECT PUSH _ <br /> I I INJECTION <br /> r VAPOR EXTRACTION <br /> SPARGING— <br /> SOUTH REMEDIATION_ <br /> Ill+rstrrrtc nr DLsrirbx Ulstoncc of 4Wl Fant Roads Brulclui;;s <br /> Fr nut Rivri It( and attach e nidir' Uv addrhonal y1apLI rf OTHER(SPECIFY)_ <br /> utctssnrJ PLEASE DE ACCURATE 17031FLETE <br /> W1TER LEIEL & YIELD OF COMPLETED WELL <br /> DEPTH TO FIRST WATERT (R) BELOW SURFACE <br /> I I <br /> DEPTH OF STATIC <br /> WATER LEVEL (FI}8 DATE MEASURED <br /> ESTIMATED YIELD (GPM) & TEST TYPE <br /> FUT1L DEL'T11 OF 130111V( 1E11t) TEST LENGTH (His) TOTAL DRAWDOWN (Ft) <br /> 101 I[ IN FT1[ OF { O\1PLFTCD `I ELL (EC-21 Feetl '1Lll uat be reprercnwrive of a L11j 1on1;-rows Yield <br /> DEPTH C+SING (S) DEPTH ANNULIR \fATERIkL <br /> FROM SURFACE BORE ( ) FROM SURFACE TYPE <br /> TYPE <br /> HOLE r <br /> DIA Y w o a MATERIAL/ INTERNAL GAUGE SLOT SIZE CE BE <br /> {Intoes] `a �- �- GRADE DIAMETER OR WALL IF ANY MENT TONITE FILL FILTER PACK <br /> FI o Ft Ei N cin LL (Inches} THICKNESS (Inches) FS to Ft { 1 ( �1 (�} (TYPE SIZE} <br /> I ' <br /> irTA,( 11ME`LS (�] CERTIFICATION ST,TUMENr <br /> I the undersigned certify that this report IS Complete and accurate to the best of my knowledge and belief <br /> Geologic Log <br /> Well Construction Diagram NAME <br /> (PERSON FIRM OR CORPORATION) tTYPEO PRINTED) <br /> Geophysical Log(s) <br /> •f SodlWater hernlcal Anakyges 4ODRESS CITY STATE ZIP <br /> +± Other � le9 <br /> ATTACH 400ITIONAL fNFORMA, IF IT EYISTS Signed DAT SIGNET) C 57 LICENSE t1UMBER <br /> IVF F,R/AUTHDRIZ R PRESENTATIVE <br /> tn%t I,5 l l+ T T ,- IF ADDITIONAL SPACE IS NEEDED USE NEXT CONSECUTIVELY NUMBERED FORM <br />