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- <br /> s <br /> 'The free Adobe Reader may be Used to view and corr plate this form. However,software must be pu rchased t0 complete,save,and reuse a saved form. <br /> File Original with DWR j State of California DWR Use On —Do Not Fill In <br /> Well Completion Report, <br /> Page 1 of 1 Refer to lnstawftn Pamptr/ef State Well Number/Site Number <br /> Owner's Well Number MW-6 No. e0239151 I INI I I I I Tw <br /> Date Work Began 08/29/20J4 I ate Work Ended 812912Q14 Latitude Longitude <br /> Local Permit Agency <br /> San Jdaauin County Er varonmental Health Dept- <br /> Permit Number SR#70283 I Perrr t Date 8/11/14 i APN/rRS/Other <br /> I <br /> I <br /> Geologic Lo Well Owner <br /> Orientation OVertical; O Horizontal OAngie Na e G&iY Miller Family Partnership <br /> Drilling Method Hollow Stem A`ger Driiling Fluid specify Marling Add,ess P.O.Box 336 <br /> Depth from Surface I ' ascription <br /> Feet to Feet Describe mat rias rain size,color,etc Ci TraOV State CA___Zip95378 <br /> Fill Well with neat cer ient grout and apply Well Location <br /> 25 p. i pressure for a minimum of five minutes. Ad fess 7675 West Eleventh Street <br /> Excavate top three feet to create mushroom cap. Cit Tracy I County San Joaquin <br /> I Latitude N Longitude -----VV <br /> I I 'Dep. Min. Sec. Oeo. Min. Sec. <br /> U Dat irn NA083 Dec.Lat. 37.7406317 Dec.Long.-121.400912 <br /> f AP INI Book 250 Page 140 Parcel 12 <br /> I <br /> Township IL _Ran a 5E Section 22 <br /> Location Sketch Activity <br /> { Sketch must be drawn by hand after form is nted. New Well <br /> 1 North <br /> O Modification/Repair <br /> O Deepen <br /> ' O Other <br /> Q Destroy <br /> f _ Dow1b.procod.—dnd mtlee4lo <br /> undw'GEOLOGIC LOG' <br /> Planned Uses <br /> O Water Supply <br /> []Domestic ❑Public <br /> see attached figure l ❑Irrigation ❑Industrial <br /> I <br /> t <br /> i O Cathodic Protection <br /> O Dewatering <br /> j O Heat Exchange <br /> i O Injection <br /> O Monitoring <br /> O Remediation <br /> O Sparging <br /> t South O Test Well <br /> i rpusba ardascdb.*tama ot,10 from roods.Wild-ti..f---' O Vapor Extraction <br /> iri+ers. .and aaech•map.Uw addltlonal paporanecessery. O Other <br /> I puss M acwrats'antl aom kte. <br /> Water Level and Yield of Completed Well <br /> Depth tofirst water (Feet below surface) <br /> I Depth to Static <br /> Wa ler Level (Feet) Date Measured <br /> Total Depth of Boring 1i Feet Esti ated Yield" (GPM) Test Type <br /> Total Depth of Completed Well Feet Tes Length (Hours)Total Drawdown (Feet) <br /> 'Ma, not be representative of a well's longterm yield. <br /> IC assn s Annular Material <br /> Depth from Borehole T aterial wall Outside Screen slot Size Depth from <br /> Surface Diameter Type Thickness Diameter Typ if'Any Surface Fill Description <br /> Feet to Feet (inches) Inches Inches Inches Feet to Feet <br /> 4 I i <br /> i <br /> E <br /> t <br /> Attachmehts I Certification Statement <br /> ❑Geologic Log i I,theLndersignedt certify that this report is complete and accurate to the best of my knowledge and belief <br /> ❑Well Construction Dia�ram Name r titin &Testina.Inc <br /> Person,Firm or Corporation <br /> ❑Geophysical Log(s) 950 Howe-Rd Martinez CA 94553 <br /> ❑Soil/Water Chemical Analyses redo city state zip <br /> ED Other Site Ma I Signed 10/31/2014 485165 <br /> Attach addtioral informeaw if it exists) Ic-til LiaoaWoterWel Con"torZ�1111 Date Signed C-57 License Number <br /> DWR 188 REV.1/2008 i IF ADDITIONAL SPACE IS NEEDED,USE NEX 7 CONSECUTIVELY NUMBERED FORM <br /> s <br /> t <br /> t <br /> E <br />