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I - <br /> `The free Adobe Reader may be used to view and cGm plete this form. However,software must be pu rhased tq complete,save,and reuse a saved form. <br /> File Original with DWR State of California DM Use Only—Do Not Fill In <br /> Well Completion Report! <br /> Page 1 of 1 i Refer to Instruction Pamphlet State Well Number/Site Number <br /> Owner's Well Number MW-9 No. 90239163 i N1(1 1 1 I IwI <br /> Date Work Began 08/29/201.4 late Work Ended I Latitude Longitude <br /> Local Permit Agency San Jo6auint l I i I I I I i I I I <br /> Permit Number SR#70283 I Penr t Date 8/11/14 APN/TRS/Other <br /> Geologic Lo g Well Owner <br /> Orientation O Verticall O Horizontal OAngle Specify Name G&Y Miller Family Partnership <br /> Drilling Method Hollow Stem Agger Drilling Fluid Mai Ing Address P.O.Box 336 <br /> Depth from Surface Description <br /> Feet to Feet Describe mat trial, rain size color,etc Ci Tracy: State CA�i 95378 <br /> Fill W Well with neat cer ient grout and apply <br /> Well Location <br /> 25 p'si pressure for a minimum of five minutes. Address 7675 West Eleventh Street <br /> av <br /> Excate to f three et to create mushroom cap. city TracyCounty San Joaquin <br /> Lat"ude N Longitude <br /> I Dep. Min. Sec. Dep. Min. Sea <br /> j Dat m NAD83 Dec.Lat. 37.7404655 Dec.Long.-121.4001102 <br /> AP N Book_ Page 140 Parcel 12 <br /> i Townshi 2S Ran a 5E Section 22 <br /> I Location Sketch Activity <br /> Si etch must be drawn by hand vAer form Is ted. New Well <br /> ' I North O Modification/Repair <br /> I O Deepen <br /> O Other <br /> Q Destroy <br /> OoacdM pooadwa.and makY. <br /> under GEOLOCIC LOG. <br /> Planned Uses <br /> O Water Supply <br /> E]Domestic [3 Public <br /> see, attached figure t []Irrigation ❑Industrial <br /> LLI <br /> O Cathodic Protection <br /> O Dewatering <br /> I O Heat Exchange <br /> O Injection <br /> O Monitoring <br /> O Remediation <br /> O Sparging <br /> South O Test Well <br /> rw.va�.erdaare;a.tsn 0 11 kmroad.,Mdd'.md.,knoas. O <br /> vapor Extraction <br /> miv.n.µ..end.each."p.U..aftd n.I Nps Nne coy. O Other <br /> I t>t.. tw.eeurate and oar ata <br /> Water Level and Yield of Completed Well <br /> I Depth to first water (Feet below surface) <br /> i <br /> Dep4h to Static <br /> Wa ler Level (Feet) Date Measured <br /> Total Depth of Boring Jell Feet Esti ated Yield• (GPM) Test Type <br /> Total Depth of Completed Feet Tes Length (Hours) Total Drawdown (Feet) <br /> *Menot be re resentative of a well's long term yield. <br /> IC assns ( Annular Material <br /> Depth from Borehole T aterlal Wall Outside Scre n Slot Size Depth from <br /> Surface Diameters Thickness Diameter Typ if Any Surface Fill Description <br /> Feet to Feet Inches inches Inches Inches Feet to Feet <br /> i <br /> i <br /> i <br /> I <br /> i <br /> I <br /> Attachments Certification Statement <br /> ❑Geologic Log '• I,the undersigned,Carl that this report Is complete and accurate to the best of my knowledge and belief <br /> ❑Well Construction Dia ram NameGreggdr Ilin tin I <br /> Y Person,Firm or Corporation <br /> ❑Geophysical Log(s) i 950 Howe E3d I Martine CA 94553 <br /> ❑Soil/Water Chemical Analyses Ad city state zip <br /> 0 Other Site Ma I Signed ' --1 10/3/12014 485165 <br /> A"ch switionrl Informadon K It eAsts1 C-57 LkengdWiftr woe conlro for I Date Signed C-57 License Number <br /> DWR 188 REV.112008 I IF ADDITIONAL SPACE IS NEEDED.USE NEx r CONSECUTIVELY NUMBERED FORM <br /> i <br /> I <br />