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`The freeAdobeReader may be used to view and complete this form. However,Software must be purchased to complete,save and reuse f <br /> P s saved farm. <br /> File Orlglna[with DWR State of California <br /> DWR Use 4ni –Da Nat Fill In tl <br /> Page 1 of 1 Well Completion Report <br /> Owner's Well Number S-2 Relerto tnafrocflpn Pamphlet State Wall NumbedSite Number <br /> No. 60085828L Ll N <br /> Date Work Began �- Date Work Ended a-S" W 1 <br /> Local Permit Agency Latitude Lon nude <br />' Permit Number Permit Date 12/31/08 APNfTRSIOther <br /> Geolo is Lo Well Owner <br /> Orientation OVertical O Horizontal OAngle specify [amMoller Investment Group Inc (formerly USA Gasoline) <br /> Drilling Method trilling Fluid <br /> Depth frond ftili Description Address 9 5 Ranch Conli BoulevardFeet to Feet Describe material rain size color etc wbury Park _StateCA__Zip 91320 <br /> Well Location <br /> Pressure grout with neat cement Address 2500 West Lodi Avenue <br /> Remove upper portion of well casing City-Lodi County San Joaquin: <br /> Remove vault box Lalilude N Longitude "' <br /> Patch ground surface Dee Min. Sec Deo. Min. Sec W <br /> Datum Decimal Lai. Decimal Long, <br /> APN Book W-1 Page"4- Parcel' LL& <br /> Township -Range Section <br /> Location Sketch Activit <br /> Sketch must he drawn by hand after form is printai New Well <br /> North IO Modification/Repair <br /> i' O Deepen <br /> 5� <br /> Cm I O Other e <br /> Destroy <br /> De1c0b.pr—fun.rad m.Salai. <br /> ..J.GEOLOGIC LOO' <br /> Planned Uses <br /> O Water Supply <br /> ❑Domestic ❑Public <br /> ❑Irrigation ❑Industrial <br /> O Cathodic Protection <br /> O Dewatering <br /> O Heat Exchange <br /> O injection <br /> O Monitoring <br /> O Remediation <br /> O Sparging <br /> South O Test Well <br /> Willbbi w d—ribe astmi m"M t<pm re.a,bi l.n�.a, O Vapor Extraction <br /> rb.o,etc.�nd.alwh.m.p,llra.ddaenalpop.rthwe—y. O Other <br /> Pl.u.bo aeeurah arae ce t.t.. <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 FeetEstimated Yield• (GPM) Test Type <br /> Total Depth of Completed Well 50 Feet Test Length (Hours} Total Drawdorm (Feet) <br /> [*May not be re resentative of a well's long term yield, <br /> Casings Annular Material <br /> Depth from Bprli wait Outside Screen SlotSlze Depth from <br /> Surface Dtarn= Type Material Thickness Diameter Type If Any surface Fill !' Description <br /> Feet to Feet Inches Inches Inches Inches Feet to Feet i <br /> { <br /> i <br /> Aftehiri'ents Certification Statement i <br /> ❑Geologic Log I,the undersigned,certi�that this report is complete and accurate to the best of my knowledge and belief <br /> ❑Well Construction Diagram Name Woodward r'I n! g Comoany -_ <br /> ❑Geophysical Logs) Parson.Firm orcwpwaaon <br /> ,550 River Road Rio Vista -9_A--1 94571 <br /> ❑SoIVWater Chemical Analyses .a Adgrecity Slate. Zip' <br /> 0 Other Site Plan Signed Q,.6-a g4 710079 <br /> Peach additional lnronnason If It Swale. C-57 LI ed Mir contractor Date Signed C-57 License Number <br /> Di 188 REV.112005 IF ADDITIONAL SPACE IS Ni USE NEXT CONSECUTIVELY NUMBERED FORM - <br /> F <br />