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'The tee Adobe Reader may be used to view and complete this form. However,soft-vare must be pur ased to complete,save,and reuse a savedform. <br /> File Original with DWR State of California ! 1 511UR Use Ont -Do Not:Filf.th <br /> II Completion Report <br /> Page 2 of 6 y Refer to Ir srruction Pamphlet State Well Number/Site Number <br /> Owner's Well Number MW-2 No. e(1149224 I N I �+ <br /> Date Work Began 03/26/2012 Date Work Ended 3127120,12 Latitude Longitude <br /> Local Permit Agency Ran.)nankin COU ty Environmental Health DeCr <br /> ' <br /> Permit Number SIA _ Permit Date 3122112 APNrfRSlOther <br /> Geologic Log Well..Owner.. .__. <br /> Orientation OVertical O Horizontal OAngle Specify_ Name Four B's Partnership C/O Dan Fecher - <br /> Drilling Method Hollow Stem Au er Drilling Fluid Bentonite mud i <br /> Mail ng Address 71 W. Park Avenue I <br /> : eoth from Sufac description Vineland NJ 08360 <br /> D Cit State�Zi <br /> Feet. to Feet. Describe:material rain size,color,etc <br /> 78 10 Pressure Grout <br /> Well,Locatian. . ... <br /> Add ess 2850 Loomis Rod <br /> City Stockton County San Jva uin <br /> Lati ude N Longitude <br /> Dep. Min. Sec- Dila. Min. Sea <br /> Dattim Decimal Lat. . Decimal Long. <br /> APN Book 179 Page 100 Parcel 03 <br /> TwAnship Range. Section <br /> Location'S ketch. Adtivi <br /> (Sketch must be drawn by hand after form isprinted.) O New Well <br /> North O Modification/Repair <br /> Q Deepen <br /> O Other <br /> G) Destroy <br /> OesplOe procedures Intl materials <br /> under GEOLOGIC LOG" <br /> Plannsd,Uses. <br /> �Q am wO Water Supply <br /> A <br /> [[ `� � pDomestic ❑Public <br /> ❑Irrigation ❑industrial <br /> O Cathodic Protection <br /> O Dewatering <br /> O Heat Exchange <br /> O Injection <br /> Q Monitoring <br /> O Remediation <br /> O Sparging <br /> South 0 Test Well <br /> Illus) le or pesctlbe distance Orwell aom roads.buildings,farm, Q Vapor Extraction <br /> Odwrs etand aaaarh a map,Us',additional paper if necessary. Other <br /> - Plea t o accunsa and coon hfe. 11 <br /> Water Level and Yield of Com leted.Well <br /> De 3th to first water (Feet below surface) <br /> De th to Static <br /> }N ter Level, - (Feet)„Date.Measured <br /> Total Depth of Boring 78 Feet Es imated Yield' (GPM) Test Type <br /> Te t Length (Hours) Total Drawdown (Feet) <br /> Total Depth of Gompleted Well 78 Feet <M iy not be representative of a well's long term yield, <br /> casings Annular iter'isl <br /> Depth from Boreholewall Outside Sen an Slot Size Depth from <br /> Surface Diameter Type Material Thickness Dilimeter Tye if Any Surface Fill Description <br /> Feet to Feet Inches inches hlches inches Feet to Feet <br /> ,Attachments Certification Statement <br /> © Geologic Log I,the undersigned, certify that this ieport is complete and accurate to the best of my knowledge and belief <br /> ❑Weil Construction Diagram Name All Well Abandonment <br /> Person,Firm;u Corporation <br /> ❑ Geophysical Log(s) 9245 Beatty DrivE SUile A. .,„�Sa mento CA 95826 <br /> Addriras ^- City state Zip <br /> ❑ Soil/Water Chemical Analyses _r. " _�. <br /> ❑� Other Site Ma Signed 5 ' ' 3!3012012 848359 <br /> Attach additional information 0 it exists. -57 Ioense,'Water Weil 3Ont actor Date Signed C-57 License Number <br /> DWR 188 REV.1/20013 IF ADDITIONAL SPACE IS I,IEEDED,USE NE XT CONSECUTIVELY NUMBERED FORM <br />