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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 reuse a saved form. <br /> File Original with DWR State of California OWR Use Oni -Do Not Fdl In ,h <br /> Well Completion Report <br /> Page 1 Of 1 Refer tolnstrudJonPamphid State Well Number/Site Number , j <br /> Owner's Well Number MW-8 N0. 90085834 N w <br /> Date Work Began 3-70 . Date Work Ended "� Latitude Longitude <br /> Local Permit Agencyr-., <br /> ,Zan Joaciuln unly Environmental Health Dent_ - I <br /> APNITRSrother <br /> Permit Number,SR0056234 _ Permit Date 12/31/06 <br /> Geolo Ic LogWell owner <br /> Orientation O Vertical O Horizontal OAn9Ee SpeciF Y Name Moller Investment Group, inc. (formerly USA Gasoline) <br /> Drilling Method Drilling Fluid Mailing Address 905 Rancho Cone'o Boulevard a <br /> Depth from Surface Description <br /> Feet to Feet Describe material, rainsize coloretc CityNewbury Park _State Ci4�i 91320 <br /> Well Location <br /> Pressure grout with neat cement Address 2500 West Lodt Avenue <br /> Remove upper portion of well casing City Lodi _ County San Joaquin <br /> Remove vault boxLatitude N Longitude W <br /> Patch ground Surface Dea. Min, Sec, Oea. Min._ Sec. <br /> Datum Decimal Lat, Decimal Long. <br /> APN Book dam_ Page 400 Parcel QG <br /> Townshi Range Section <br /> Location Sketch I Activity <br /> Sketch must be dwn by hand after form Is nted: New Well <br /> North 0 Modification/Repair i <br /> O Deepen', <br /> f,, O Other <br /> See .51k i14, O Destroy <br /> D--.ib.Fr du a„d m-I.r{.h <br /> ,nd.r'GEOLOGIC lOG' <br /> Planned Uses <br /> O Water Supply <br /> [:]Domestic ❑Public <br /> w ❑Irrigation ❑Industrial <br /> 0 Cathodic Protection <br /> O Dewatering <br /> 0 Heat Exchange <br /> O Injection <br /> O Monitoring <br /> O Remediation <br /> Q Sparging <br /> South O Test Well <br /> ayi.tral.a duwlw,dl.hna.rw-n sem ro.da,d,uarw..)ante-. 0 Vapor Extraction , <br /> Owe,-7c.ane-Bach.m-P.W--tldYl"P-Pwlrnee.w-y. O Other <br /> PN-x pa-carat--d wm bb. <br /> assississis <br /> Water Level and Yield of Completed Well <br /> Depth to first water i (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 repro niative of a.well's long term yield. <br /> Caapi s Annular Material <br /> Depth from Borehole Wall Outside Screen Slot Size Depth from <br /> Surface Dismstar Type Material .Thickness Diameter Type If Any Surface Fill Description <br /> Feet td Feet Inches Inches Inches Inches Feet to Feet <br /> AtUchments Certification Statement I <br /> I <br /> Geologic Log I,the undersigned,certify that this report is complete and accurate 10 the best of my knowledge and belief <br /> ❑Well Construction Diagram Name Woodward Drilling Comoanv i <br /> Person,F3rtn or <br /> Corporation <br /> ❑Geophysical Log(s) 550 River Road Rio Vista CA 94571 <br /> ❑Soiwvater Chemical Analyses Ade}rms City stale zip <br /> M Other Site Plan Signed QL- Cl 710079 <br /> Attach additional In -57 Licensed w raven contractor Date Signed' C-57 License Number <br /> OWR 188 REV,112008 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br /> I <br />