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'The free Adobe Reader may be Used to view and corn Aete this form However,software must be pui chased to complete,save,and reuse a saved form. <br /> File Original with DWR ! State of California ! DWR Use Only-Do Not Fill In <br /> Well Completion Report <br /> Page 1 Of 1 ! Rotor to Instruction PamlMkf i State Well Number/Site Number <br /> Owners well Number DP-31 No. e0239212 W <br /> Date Work Began 08/261201!4 ate Work Ended 812612014 Latitude Longitude <br /> Local Permit Agency in Co tal Health Dept. I I 1 I i t t I I I I <br /> Permit Number S13#70283 Perm Date 8/11/14 APN/TRS/Other <br /> 1 ' Geologic Lo Well Owner <br /> Orientation O Vertical li 0 Horizontal OAngle Specify Na a CL&Y Miller Family Partnership <br /> Drilling Method Hollow Stem Auger Drilling Fluid Mai Ing Address P.O.BOX 336 <br /> Depth from Surface I lescription Tracv State C—_Zi 95378 <br /> Feet to Feet Describe mat vial rain size color,etc CI <br /> Overdrill to 25 feet bc,s.,backfill to surface Well Location <br /> with heat cement gro it. Address 7675 West Eleventh Street <br /> City Tracy County-San Joaquin <br /> Lati ude N Longitude —Yy <br /> Dep. Min. Sec. Dap. Min. See. <br /> Dat NAD83 Dec.Let. 37.7405415 Dec.Long.-121.4004046 <br /> AP Book 250 _ Page 140 Parcel 12 <br /> To nshi 2S Range 5E Section 22 <br /> Location Sketch Activit <br /> s etch must tie drawn by hand after form is ted. New Well <br /> North O Modification/Repair <br /> I O Deepen <br /> i O Other <br /> O Destroy <br /> preudures and mwrlds <br /> ane.r�eo�oolc LOW <br /> Planned Uses <br /> ! see attached figure [3Do esticSupply <br /> g ❑Domestic []Public <br /> w ❑Irrigation ❑Industrial <br /> O Cathodic Protection <br /> O Dewatering <br /> O Heat Exchange <br /> O injection <br /> O Monitoring <br /> O Remediation <br /> I O Sparging <br /> O Test Well <br /> South O Vapor Extraction <br /> plusY er Msttiee ASMaa ei v J hm reads,buildinp lines, O Other <br /> Men, G.and aeadi•msp.the addltic-I P.Per aeecsessry. <br /> Plias Maeeurats'ana sem Nle. <br /> i ater Level and Yield of:Completed Well <br /> Depth to first,water (Feet below surface) <br /> ' Depth to Static <br /> Water Level. (Feet) Date Measured <br /> Total Depth of Boring I Feet Esti ated Yield" (GPM) Test Type <br /> Feet Tes Length (Hours) Total Drawdown (Feet) <br /> Total Depth of Completed Weli -Ma not be representative of a well's Ion term yield. <br /> 1 <br /> Casings <br /> Annular Material <br /> Depth from Borehole Wall outside Scre'n Slot Size Depth from <br /> Surface Diameter I Type terlal Thickness Diameter Typ if'Any Surface Fill Description <br /> Feet w Feet Inches Inches Inches Inches Feet to Feet <br /> I <br /> i <br /> 1 . <br /> i <br /> Attachments 1 Certification Statement <br /> ❑Geologic Log I,the undersigned,certi that this report is complete and accurate to the best of my knowledge and belief <br /> ❑Well Construction Diagram Name Gre40 Dnlllnt.to Testing Inc <br /> Person,Firm or Corporation 4553 <br /> ❑Geophysical Log(s) 5 Howe d Martinez CA .� <br /> ❑SoiIMlater Chemical ASired nalyses ae s city state YIP <br /> El Other Site Ma 9 1/31/2014 485165 <br /> Attach addI1101141 raormation if It ostsi J1 C-57 need water We]Cony ; Date Signed C-57 License Number <br /> DWR 188 REV.112008 IF ADDITIONAL SPACE IS NEEDED,USE NE CONSECUTIVELY NUMBERED FORM <br />