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;I <br /> i <br /> 1 The free Adobe Reader may be used to view and complete this form.However,software must be purchased N complete,save,and reuse a saved roan. <br /> File Original with DWR State of Califomia DwR.Use ON -Do Not Fill In <br /> Well Completion Report <br /> Page 11 of 1 Referte lnshudon Pamphlet SiffieWell Number/Site Number <br /> L�-1-'� <br /> No. e0131975 N w <br /> Owner's Wall Number MW-7 Lon aude - <br /> Date Work Began �6-3L- O i Date Work Ended 4-2,(-1/ Latitude <br /> Local Permit Agency San 10anum County Environmental Health Department I I <br /> gpNrtastOther <br /> Permit Number SR0062436 Permit Date 5/4/11 l <br /> Geologic Log Well Owner <br /> Orientation OVerical O Horizontal OAngle specify. Name Shell Oil Products US <br /> Ddlling Method Hollow Slem Abler Drng Fluid Mailing Address 20945 South Wilmington Avenue <br /> Depth from surface Description - CI Carson StateCA_ Zl 90810 <br /> Feet m Feel Describe material, min size color,etc <br /> The well box was removed and the well drilled out. Well Location <br /> The well casing was removed and the borehole Address 2320 North EI Dorado Street <br /> backfilled with cement. The surface was patched city Stockton County San Joaquin <br /> with concrete Latitude N Longitude pea. Min sec."w <br /> Dep. Min Sew <br /> li. Datum Decimal Lat. _ Decimal Long. <br /> APN Book - Page Parcel I I <br /> Township Range - Section <br /> Ldcation SketchActivi <br /> sketch mudbedrewn by here aaertmm is MWd- ONew Well ,I <br /> II .0 Modification/Repair <br /> j� 1 O Deepen <br /> \ O Other <br /> _ sTO Destroy <br /> VENTS ,, OxuMe WxMuwi,tl maleMk <br /> 1 ,'r uder'GEeIeGICLOc <br /> `-ID NTP- Planned Uses <br /> I L <br /> • luw-s O Water Supply <br /> []Domestic ❑Public <br /> �Y ❑Irigafion ❑Industrial <br /> O Cathodic Protection <br /> 0 Dewatering <br /> I, ya /- 0 Heat Exchange <br /> II zee/' 0Injection <br /> v� O Monitoring li <br /> OT O Remediation. <br /> FAST40AryjS STR O Sparging <br /> O Test Well <br /> I - O Vapor Extraction <br /> merareoreexft-h.a,w U.ahum,nMa.WMLpa.r"i <br /> m<n,em.am wam a maP.use.adaa�omerareataan. O Other <br /> Please m accurate and aem lele. - <br /> IIt <br /> at Level and Yieldof Completed Well I Depth to first water^/A (Feet below surface) <br /> r ' Depth to Static <br /> 11 Water Level /--A (Feet) Date Measured AM <br /> Total Depth of Boring 50Feel Estimated Yield a " (GPM) Test Type A,lA <br /> Total Depth of Completed Well 0, _ Feet Test Length NA- (Hours)Total Drawdown JVQ (Feet) <br /> _ <br /> `Ma rot be re resentative of a well's Ion term ield. =- ,--- <br /> n <br /> Casings Annular Material <br /> Depth from Borehole Wall Outside Screen Slot Size Depth from <br /> (Surface Diameter Type Material Thickness Diameter Type If Any Surface Fill Description <br /> Feet to Fast n hes Inches Inches) (InchesL eet to Feet <br /> 1 11 <br /> I I1 I <br /> n Attachments Certification Statement <br /> �. ❑Geologic Log +. I,the understried,certi is rt is complete and accurate to the best of my knowledge and belief <br /> 0 Well Construction Diagram Nameq <br /> 0 Geophysical Log(s) 4?fgyw r / E CA <br /> r <br /> M Soil/Water Chemical Analyses - Signed /yr-..�� city <br /> �� �l <br /> 13 Other <br /> Altedt adrillamllMarmaaon MlteNsls. Cfi?L ate-wall Cormussr clateSined C-57 License Number <br /> Dw1k19e REV.14C06 IFADDITIONA SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />