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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 foim. <br /> Fife Original with DWR State of Califomla DWR Use On —Do Not F171 In <br /> `Page W of t Well Coompletion Report C <br /> State Well Numbed <br /> Owner's Well Number MW-8 No 4'1644 90 ; Number <br /> Date Work Began 07 Date Work Ended t Latitude N Lon €Suds W <br /> Local Permit AgZO <br /> Permit Number ,D S 0 D ')— Permit Date <br /> APNrrRSIOther <br /> Geolo Ic"Lo WellOwner <br /> Orientation O Verfical O Horizontal OAngle Specify Name Phillips 66 <br /> Drilling method Detling Fluid Mailing Address 76 Broadway <br /> Depth from Surface Description Sacramento CA 95618 <br /> Feet to Feet Describe material rain size color'etc Cit State 1 <br /> Well Location <br /> well overdrilled to total depth,backfilled with Address 2375 N.Tracy Blvd, <br /> cement grout,surface repaired to match existing City Tracy - _ _ County San Joaquin <br /> grade Latitude N Longitude _yu <br /> Dep. Min, Sec. Dep. Min. Sec. <br /> Datum Decimal Lat.- Decimal tong. <br /> APN Book Page Parcel, <br /> TownshlD Range Section <br /> Location Sketch Activityy <br /> ketch mus!be drawn by hard after form Is ed. t0 New Well <br /> North O ModificationlRepair <br /> O Deepen <br /> O Other <br /> O Destroy <br /> o-.*e r��es ens i mtalab <br /> ,mde'OEOLOOIC LOW <br /> Planned Uses- <br /> V\, l O Water Supply <br /> Cites-i �4• t, ❑Domestic ❑Public <br /> � ( . ❑Irrigation ❑Industrial <br /> Lu <br /> O Cathodic Protection <br /> s O Dewatering <br /> O Heat Exchange <br /> O Injection j <br /> w y OMonitoring <br /> O Remediation <br /> 4 O Sparging <br /> So O Test Well <br /> fttetau d—ribe&M—1-1 roeft,eamv.,le&". O Vapor Extraction <br /> dwn,erc.edshed,amep.lbsadffa.arpWv IInece*wy. O Other <br /> _ - PN�Gacana4vmdc <br /> Water Loveland Yield of Com feted 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 Yleld• (GPM) Test Type <br /> Total Depth of Completed WellFeet Test Length (Hours)Total Drawdown (Feet) <br /> *May not be re resentative of a well's long term yield. <br /> Casings Annular Material <br /> Depth from Borehole Wall Orrtsldo Screen Slot Size Depth from <br /> Surface Df meter Typo Matorlal Thickness Diameter Type If Any Surface Fill Description <br /> Feet m Feet Inches Inches Inches Inches Feet to Feet <br /> Attachments" Certification Statement <br /> ©Geologic Log I,the un ned ls+report is complete and accurate to the best of my knowledge and belief <br /> ❑Well Construction Diagram Name /�yr <br /> ❑Geophysical Log(s) CA <br /> ❑other ter Chemical Analyses cityllZ stait <br /> 13 other Signed <br /> Attach addiiwrel frtyanaftrl V it adsls. Date S' ned C-57 License Number <br /> DWR 168 REV.1/[006 IF ADDITIONAL SPACE IS NEEDED,USE NEXT OONSECUrIVELY NUMBERED FORM <br />