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1 i <br /> I <br /> 'The free Adobe Reader may be used to view and com plete this form. However,software must be puchased to complete,save,and reuse a saved form. <br /> File Original with DWI State of California DWR Use Only-Do Not Fill In <br /> Well Completion Report' <br /> Page 1 of 1 I Refer to/nstrnc6on Pamphlet State Well Number/Site Number <br /> Owner's Well Number MW-2 No. e0239162 I N w <br /> Date Work Began 08/25/2014 1 ate Work Ended 14 Latitude Lon ituda <br /> Local Permit Agency San Jobauin County Er vironmental Health DeDt. <br /> Permit Number SR#70283 Perm t Date 8/11/14 j APNrrRS/Other <br /> I <br /> Geologi <br /> c Well Owner <br /> Orientation OVerticali O HoriOAngle Specify Na a 0 A Y Miller Family Partnership _ <br /> Drilling Method Hollow Stem AJ erDrilling Fluid Mai Ing Address P.O Box 336 <br /> Depth from Surface I .grain <br /> Tracy; State Chi 95378 <br /> Feet ro Feet Describe , rain size color etc Ci Overdrill to 35 backfill to surface Well Location <br /> with'neat cement gro it. Adilress 7675 West Eleventh Street <br /> Ci Tract/, County San Joaquin <br /> Laf ude I N Longitude _yy <br /> Deg. Min. Sec. Dep. Min. Sec. <br /> Dat m NADe3 Dec.Lat. 37.7404652 Dec.Long.-121.400341 <br /> AP N Book Page 140 Parcel 12 <br /> ToWnshi S Ran2e 5E Section 22 <br /> Location Sketch Activit <br /> Sketch must be drawn by hard aRsr form is d. 0 New Well <br /> j North 0 Modification/Repair <br /> I O Deepen <br /> O Other <br /> Q Destroy <br /> t%acrtD�procadara and m Ledge <br /> i under GEOLOGIC LOG' <br /> i <br /> Planned Uses <br /> 0 Water Supply <br /> see attached figure ]]Domestic ❑Public <br /> W ❑irrigation ❑Industrial <br /> W <br /> 0 Cathodic Protection <br /> l 0 Dewatering <br /> i 0 Heat Exchange <br /> 0 Injection <br /> 0 Monitoring <br /> 0 Remediation <br /> 0 Sparging <br /> 0 Test Well <br /> South <br /> CusW a desaibe'distence of wort tram mck.bMdd'egs,rancss. O Vapor Extraction <br /> Mere,pp11aa end attas4 a map•use addias l paper if neceuary. O Other <br /> PIw♦Maaomft-d coplK. <br /> Water Level and Yield of Completed Well <br /> I <br /> I Depth to first water (Feet beknnr surface) <br /> Depth to Static <br /> Wal or Level I (Feet) Date Measured <br /> Total Depth of Boring i Feet Esti ated Yield' (GPM) Test Type <br /> Tes Length (Hours)Total Drawdown (Feet) <br /> Total Depth of Completed Well Feet *Manot be�e resentativto of et well's long term yield. <br /> asin s ( Annular Material <br /> Depth from Borehole I T aterial wall Outside Screen Slot Size Depth from <br /> Surface Diameter i Type Thickness Diameter Typ iflAny Surface Fill Description <br /> Feet to Feet Inches i Inches Inches Inches Feet to Feat <br /> t <br /> I <br /> i <br /> I <br /> E <br /> Attachmehts i Certification Statement <br /> ❑Geologic Log 1 I,the undersigned,certify that this report is cgmplete and accurate to the best of my knowledge and belief <br /> 13 Well Construction Dia ram Name Greaa Drilling&Testing.(n <br /> dp Person,Firm or Corporation I <br /> ❑Geophysical Log(s) ( 950 Howe d Martinez Com/_ 94553 <br /> ❑Soil/Water Chemical Analyses rasa city Stara zip <br /> O Other SiteMa I Signed 10/31/2014 485165 <br /> Attach tddilianAl iMormmfion if It•xlstai C57 Ut�n d Wdervv.1 Con for Date Signed C-57 License Number <br /> DWR 198 REV.1/2009 j IF ADDITIONAL SPA IS NEEDED,USE NEX r CONSECUTIVELY NUMBERED FORM <br /> i <br /> i <br /> I <br /> r <br /> �I F <br />