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l .....:., .,.._:.:-s_! .. .,•-,...,:.. -..«.n_a.,'.. _.. . __ .v !.. ...h !hn .! ^w„ x. ! .w. 4i.� .t< ,sa csGK-rv� <br /> 'Thu free Adobe Reader may be used to view and complete this form. However,software must be purchased to complete,save,and rause a saved form. <br /> R,. <br /> File Original with DWR State of California DWR use Ord -Do Not Fill In <br /> Page of Well Completion Report <br /> Refer tofnsinidlonPamphter State Wall Numberl5ite Number. <br /> Owners Well Numb r MW-6 No. e0085843 F'T"�NW <br /> Date Work Began 3-17 Date Work Ended 01-5-04 Lakitude Longitude <br /> Local Permit Agency San.laaouin_County-Env(tonme(Llhealth Dept. <br /> Permit Number SR0056234 Permit Date 12/31108 APNITRSIother <br /> Geologic Log Well Owner :;I ! <br /> Orientation O Vertical Q Horizontal OAngle Specify Name Moller Investment Group. Inc.(formerly USA Gasoline) <br /> Drilling Method Drilling Fluid Mailing Address 905 Rancho Conelo Boulevard I. " <br /> Depth from Surface Description <br /> Fast to Feet Describe material rain size color,etc City Newbury Park_ - _Stats_CA, Zi 99320 <br /> Well Location <br /> Pressure grout with neat cement Address 333 Lower Sacramento Road <br /> Remove upper portion of well casing City Lodi County Sari Joaquin J <br /> Remove vault box Latitude N Longitude iyv <br /> Patch ground surface Dau. Min. Sec, Deo. Mia Sec. <br /> Datum Decimal Lat. Decimal Long. <br /> APN Book OZ:7 Page q6D Parcel 05 <br /> Township -Range Section <br /> Location Sketch Activit <br /> Sketch must be drawn by hand after form Is nted. New Well <br /> NOS' Q Modification/Repair <br /> O Deepen', <br /> IIy !1 O Other <br /> Destroy <br /> D..cdb.proeeduu and maNnel. <br /> ender'GEoIOGIC LOG' <br /> Planned Uses <br /> Q Water Supply <br /> ❑Domestic'❑Public <br /> Lu [Irrigation ❑Industrial <br /> O Cathodic Protection <br /> O Dewatering <br /> O Heat Exchange <br /> O InJection <br /> Q Monitoring it <br /> O Remed#alion <br /> Q Sparging <br /> South O Test Well <br /> Itlengat.a d„enbt ee.nhes at vas Iran rsaM,building..lanes. .Q Vapor Extraction - <br /> rlw,a,.le..hd.0 eh.map.U...dahi—I pap.if n.ee y. -Q Other <br /> PI....h.aaawae..nd eo r.Y- <br /> ater Level and Yield of Completed Weil <br /> Depth to first water (Feet below surface) <br /> Depth to Static <br /> Water Level (Feet) Date Measured I <br /> Total Depth of Boring Feet Estimated Yield' (GPM) Test Type <br /> Total Depth of Completed Well 60 Feet Test Length (Hours) Total Drawdown (Feet) <br /> *Manot be re resentative of a well's long term yield. <br /> Casings Aitrfular Material <br /> Depth from Borehole T e Material wall Outside Screen Slot Size Depth from <br /> Surface Distnster -Typo Thickness Diameter Type If Any Surface Fill Description <br /> Feet ro Feet Inches Inches inches Inches Feet to Feet <br /> Attachments Certification Statement i <br /> ❑Geologic Log I,the undersigned,certify that this report is complete and accurate to the best of my knowledge and belief <br /> ❑Well Construction Diagram Name Woodward Dril i=113 anX <br /> ©Geophysical Lo Perron.Firm w Corporation <br /> g(S) 550 River-Road Bio Vista -- 94571 <br /> ❑SolWyater Chemical AnalysesAgdress a slate Zip <br /> ED Other -�Sitg_Plan_ Signed q 710079 <br /> Attae t addltlanal Inrammllion a It exists. C-57 LICensed ater Wes ContradOr Dae Signed C-57 License Number <br /> DWR 188 REV,1/1000 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />