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'The free Adobe Reader may be used to view and complate this form: However,software must be purchased to complete,save,and reuse a saved form, <br /> :r. <br /> File Original with DWR State of California DWR Use Only-Do Not Fill In <br /> I Page 1 of 1 Well Completion Report j <br /> Refer tolnsfnxtonPamphlet State Well Number/Site Number l <br /> Owner's Welf Number MW-7 No. e00$5840 N R <br /> Date Work Began 2-:j:m Date Work Ended 2-5-0 Latitude Longitude <br /> Local permit Agency_SarL,loaauln County.E,nv€ronmental Health Dept. <br /> Permit Number SR0056234 Permit Date 12131106 APNlTRSlother � <br /> Goolotlic.11.00 Well Owner <br /> Orientation 'OVerticai 0Horizontal OAngle Specify Name Mailer Investment Group, Inc. (formerly IDSA Gasoline <br /> Drilling Method Drilling Fluid Mailing Address 905 Rancho Cone€o Boulevard__ I <br /> Depth from Surface Description C€ Newbury Park StateCi g� 2Q'' <br /> Feet to Feet Describe material rain size color,etc <br /> Well Location <br /> Pressure grout with neat cement Address _Lower-Sacramento Roa I <br /> 41_ <br /> Remove upper portion of well casing City Lodi County San Joaquin : <br /> Remove vault box Latitude N Longitude �N 4 <br /> Patch ground surface Deo. Min. Sec. pea. Min.l Sea <br /> Datum Decimal Lat. Decimal L-o7ng. <br /> APN,Boakf7� Page 00 Parcell 1 <br /> Township Ran a Section <br /> Location Sketch Activit `IlI <br /> Sketch moot tw drawn by hand eRerform Is printoO 0 New Well f' <br /> North Q ModificabonlRepair fff <br /> O See Deepen <br /> o Other <br /> iQ Destroy <br /> pescrlppr and malrrieh <br /> - ,Meer'G LOGIC GIC LOG" <br /> Planned Uses <br /> Water Supply <br /> PPIY <br /> ❑Domestic ❑Public <br /> w ❑Irrigation ❑Industrial <br /> Cathodic Protection <br /> .O Dewatering <br /> 0 Heat Exchange <br /> i O Infection <br /> O Monitoring <br /> O Remediation' <br /> O Sparging <br /> South .O Test Well <br /> Mmiror.erde.Mb.ern.e.eermnI—road..buildln,..re.e... 0 Vapor Extraction <br /> i <br /> rivers,ato.Pod.ea.H•mop.Use.ddli—I p.p.,lr n.e.n.ry. Q Other <br /> Pias.b.as wd.and co d►. <br /> atertavel 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 Feet Estimated Yield` (GPM) Test Type <br /> Total Depth of Completed well 60 Feet Test Length (Hours) Total Drawdown (Feet) <br /> "May not be representative of a well's lon2 term yield. <br /> Casings Annular Material <br /> Depth from Borehole Material wall Outside Screen Slot Size Depth from <br /> Surface Dlamoter Type Thickness Diameter Type I1Any Surface FIB Description <br /> Feet to Feet Inches Inches Inches Inches Feet to Feet <br /> I <br /> � I <br /> W Attachments Certification Statement <br /> ❑Geologic Log 1,the undersigned,certify that this report Is complete and accurate to the best of my knowledge and belief <br /> 13 Well Construction Diagram Name Woodward Dril€na Comoanv <br /> Person,Finn or Corporation <br /> ❑Geophysical Lo S 550 River <br /> Road _ __ _ Rio Vista CA 94571 <br /> ❑ SoillWater Chemical Analyses Ayes: City stele DO <br /> I] Other,51te Plan Signed aA. 710079 1 <br /> Attach additional IMwntation it it mets. C.57 Liceneea er wen contractor Date Signed C-57 License Number <br /> DWR 188 REV.WOM IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br /> I <br />