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'The free Adobe Reader may be Osed to view and con plate this form. However,software must be purchased to complete,save,and reuse a saved form. <br /> File Original with DWR State of California i DWR Use Only—Do Not F01 In <br /> ' Well Completion R port <br /> Page 1 Of 1 C Refer to Instruction PamphletI State Well Number/Site Number <br /> Owner's Well Number MW-7: No. e0239170 N I I I I IW <br /> Date Work Began 08/27/20J4 Mate Work Ended Latitude Longitude <br /> Local Permit Agency <br /> Permit Number SR#70283 Per it Date 8/11/14 I APNfTRS/Other <br /> GoologicLog Well Owner <br /> Orientation OVerticall O Horizontal OAngie Specify NarYle G&Y Miller Family Partnership <br /> Drilling Method Hollow Stem A er Drilling Fluid <br /> Depth from Surface ascription Ma ling Addess P.O.Box 336 <br /> Feet to Feet Describe ma riel rain size color,etc <br /> Ci Tracv; State CA Zi 95378 <br /> Ove drill to 25 feet b js.,backfill to surface Well Location <br /> with neat cement r Lit. Address 7675 West Eleventh Street <br /> C4 San County,San Joaquin <br /> Lat;tude N Longitude _yv <br /> .11 Min. Sec. Dep. Min. sec. <br /> Datum NAD83 Dec.Lat. 37.7408463 Dec.Long.-121.4005 <br /> AP INI Book 250 Page 140 Parcel 12 <br /> ToV nshi 2S Ran a 5E Section 22 <br /> Location Sketch Activit <br /> Sketch must be drawn by hand after form Is ted. NEW Well <br /> North O Modification/Repair <br /> O Deepen <br /> + <br /> O Other <br /> i O Destroy <br /> Doo«ib.procedw" nd miaMb <br /> onder'Oe01,001C LOG, <br /> Planned Uses <br /> ;attached figure O Water Supply <br /> see <br /> ❑Domestic ❑Public <br /> m ❑Irrigation [Industrial <br /> ILL) <br /> O Cathodic Protection <br /> i O Dewatering <br /> I O Heat Exchange <br /> O Injection <br /> i O Monitoring <br /> O Remediation <br /> O Sparging <br /> South O Test Well <br /> ICuatr son d.sabe�dalonco otwPeom reado,bu9dinps,tonus, O Vapor Extraction <br /> Mow, t,- aeach a m.P•Use amisma p.per r nec ry. O Other <br /> Pte. b..—raw-d comptele. <br /> Nater Level and Yield of Completed Well <br /> De nth to fast water (Feet below surface) <br /> De th to Static <br /> Wa er Level; (Feet) Date Measured <br /> Total Depth of Boring Feet Esti ated Yield' (GPM) Test Type <br /> I Tes Length l (Hours)Total Drawdown (Feet) <br /> Total Depth of Completed Well Feet +Ma not beirlpresentative of a well's long term field. <br /> assn s ; Annular Material <br /> Depth from Borehole I Wall outside Scre n 310t Size Depth from <br /> Surface Diameter ! Type aterial Thickness Diameter Typt6 If;Any Surface Fill Description <br /> Feet to Feet (Inches) I (inches), Inches Inches Feet to Feet <br /> I <br /> i <br /> i <br /> Attachments Certification Statement <br /> ❑Geologic Log I,the undersigned,cerci that this report is complete and accurate to the best of my knowledge and belief <br /> ❑Well Construction Diaigram Name re Dr(lin estin <br /> Person.Firm or Corporation <br /> ❑Geophysical Log(s) i 0 e PA I Martinez CA 94553 <br /> ❑Soil/Water Chemical Analyses dcity State zip <br /> O Other it Ma dress I Signed 10/31/2014 485165 <br /> Attach edditionLi irwtoffnsHon.It It exists; c-57 Vi water wen Conha0or ! Date Signed C-57 License Number <br /> DSR tae REV,112006 I IF ADDITIONAL SPACE IS NEEDED,USE NEXT-CONSECUTIVELY NUMBERED FORM <br /> i <br />