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I I <br /> -The free Adobe Reader may bel used to view and cor 1plete this form. However,software must be prchased to complete,save,and rause a saved form. <br /> File Original with DWR State of California ; DWR Use Only-Do Not Pill In <br /> Well Completion Report) <br /> Page 1 of 1 Refer to Instmaflon Pamphf j State Well Number/Site Number <br /> Owner's Well Number MW-8 No. e0239171 N w <br /> Date Work Began 08/27!20`14 ate Work Ended ! 7 1 Latitude Lon itude <br /> Local Permit Agency i I t APN7TRsl0ther <br /> PernitNumber LR#702831 Per it Date 8/11/14 <br /> Geologic L4g Well Owner <br /> Orientation O Vertical O Horizontal OAngle specify Name G&'Y Miller Family Partnership <br /> Driaing Method Hoilow stem Au er Drilling Fluid Mauling Address P O Box 336 <br /> Depth from Surface ! Description Ci( TracV' State CA i 95378 <br /> Feet to Feet Describe m erial rain size,color,etc <br /> Overdrill to 25 feet s., backfill to surface I Well Location <br /> With neat cement r ut. Ad ress 76715 West Eleventh Street <br /> City Tracy' County San Joaquin <br /> Latitude N Longitude <br /> Deq. Min. Sec. Dee. Min. Sea <br /> Da um NAD83 Dec.Lat. 37.7409839 Dec.Long. 121.400523 <br /> AP Book 250 Page 140 Parcel 12 <br /> To 'hip .�—Ran e 5E Section 22 - <br /> Location Sketch Activit <br /> Sketch must be drawn b hand atter ram Is ted. New Well <br /> North O Modification/Repair <br /> O Deepen <br /> O Other <br /> Q Destroy <br /> I0—be procadr.s.nd­W.1. <br /> ".,'GECLCGIC LOG' <br /> Planned Uses <br /> I <br /> Water Supplysee!attached figure [-]Domestic <br /> ❑Public <br /> a ❑Irrigation ❑Industrial <br /> Lu <br /> l ! O Cathodic Protection <br /> O Dewatering <br /> I O Heat Exchange <br /> O Injection <br /> O Monitoring <br /> O Remediation <br /> O Sparging <br /> i <br /> South O Test well <br /> euw u«�..ceb.mat.no..rwa sem roads,eu'k'rys,[encs., O Vapor Extraction <br /> k.­d atfear■mep, <br /> the eddRionef pepsr ifn.c.s.«y. O Other <br /> piee>(e b.aceurab a a. <br /> Water 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 Estimated Yield" (GPM) Test Type <br /> Total Depth of Completed Well Feet <br /> Test Length! (Hours) Total Drawdown (Feet) <br /> "M8 not be,representative of a well's long term yield. <br /> ! Casings Annular Material <br /> Depth from Borehole I Wali Outside Screen Slot Size Depth from <br /> Surface Diameter Type ateriki Thickness Diameter Type If Any Surface Fill Description <br /> Feet to Feet inches I Inches Inches Inches Feet to Feet <br /> I <br /> I <br /> f <br /> I <br /> I <br /> I <br /> Attachments Certification Statement <br /> ❑Geologic Log I,the undersjg� i tt ffttis oq is complete and accurate to the best of my knowledge and belief <br /> ❑Well Construction Diagram Name�_((�p9 c«poj(pyJ/«� /� ry <br /> ❑Geophysical Log(s) 9Lrd 71ri ct" Y'ra • — CA <br /> ❑Soil/Water ChemicatAnalyses A as ' city state <br /> ❑� Other •t Signed t✓�� j f Cf��.(ls" <br /> Attach addificnal information If R eAsk C-57 Lk#aW water Well Conry aor Date SI ned C-57 License Number <br /> OWR tae REV.1120013 i IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br /> i <br /> i � <br />