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€ The free Adobe Reader may be used to view and complete this form. However,software must be purchased to complete,save,and rouse a saved form. <br /> File Original with DWR State of California DWR Use Onl -Do Not Fill In <br /> Page of x Well Completion Report <br /> Refer Iohistrymon Parmptifer l L Stale Well Numbed5ite Number <br /> Owner's Well Number MWA No. 80085828 N :i. w <br /> Date Work Began a^ 1 Date Work Ended 2-S`0i Latitude " Longitude <br /> Local Permit Agency$an.toaatlln�,=ty Environmental dealth Wil, <br /> Permit Number SR00,§8234 Permlt Date 12/31/08 APNITRS1Other <br /> Geolo is Log Well Owner ,,. <br /> Orientation O Vertical O Horizontal OAngle Specify Name Moller Investment Group, Inc.(formerly USA Gasoline <br /> Drilling Method Drilling Fluid Mailing Address 90.5 Rancho Cone o Boulevard <br /> Depth from Surface Description Newbury Park <br /> Feet to Feet Describe material rain size color,etc Cit _ State_CA __Zip 91320 <br /> Well Location <br /> Pressure grout with neat cement Address 2500 West Lodi Avenug _ <br /> Remove upper portion of well casing City Lodi County 5an_Joaquln <br /> Remove vault box Latitude N Longitude �yd <br /> Patch ground Surface Deli. Min. Sec. Deo. Mia Sec. <br /> Datum Decimal Lat. Decimal Long,' <br /> APN Book OZ. Page 400 Parcel b(o _ <br /> Townshi -Range Section r <br /> Location Sketch Activity <br /> - <br /> (Sketchmustbe drawn hand Biter torm is 'ted. New Well <br /> North <br /> Q ModificatiaNRepair <br /> O Deepen.,. <br /> O Other <br /> :O Destroy` P� Naas p—d."Bnd meted.t. <br /> uMWGEaLOGIG Loci' <br /> l Planned Uses <br /> 0 Water Supply <br /> []Domestic OPublic <br /> W [Irrigation ❑Industrial <br />' O Cathodic Protection <br /> E <br /> O Dewatering <br /> .O Heat Exchange <br /> O Injection <br /> O Monitoring r <br /> f O Remediation <br /> 0 Sparging <br /> South �O Test Well <br /> auetr.l.«dnerne diMm"at"11 m.m...d.,bullonw,tine.., O Vapor Extraction <br /> rly .,W..nd.Baeh a m.p.u"fiddlliw i paps M n.oe...ry, 0 Other <br /> PI..N Mxctu U Md con l.b. <br /> Water Level tend Yield of Com Rioted Well <br /> Depth to first water (Feet below surface) <br /> Depth to Static <br /> Water Level (Feet) Date Measured <br /> Total Depth of Boring Feet Estimated Yield (GPM) Test Type t <br /> Total Depth of Completed Weil 60 Feet Test Length (Hours) Total Drawdown (Feet) I <br /> *May not be representative of a well's long term yield. <br /> Casings Annular Material <br /> Depth from Borehole Wail Outelde Screen Slot Size Depth from jI t€• <br /> Surface Diameter Type Material Thickness Diameter Type If Any Surface Fill'," Description <br /> Feet to Feet Inches Inches inches Inches Feet to Feet <br /> + I <br /> ,.i <br /> t <br /> t <br /> Attachments Certification Statement <br /> Geologic Log 1,the undersigned,cert1fy that this report Is complete and accurate to the best of my knowledge and belief <br /> E3 Well Construction Diagram Name Woodward DrElllno ComDanv <br /> ©Geophysical Log($) 650 River NmonRoad Firm�Corporation RID Vlstp CA 94571 <br /> ❑SolWdater Chemical Analyses Add % city state zip <br /> 0 Other �lte Elan Signed 710079" <br /> Allech additional IrftrMeaon if It e4juir C-57 Licensed w es conbaclor Date Signed' C-57 License Number <br /> DWR 1 a REV.1/20M IF ADDITIONAL SPACE 19 NEEDED,USE NEXT CONS£CVTIVELY NUM8ERED FORM +' '" <br />