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;a <br /> *The free Adobe Reader may be used leA aW and Dorn/ <br /> File Original with DWR his form. HOwever,software must be purchased tocomptete, <br /> State of Cattfomti,j and reuse a saved fOrrn. <br /> Page 1 � of r� DVyR k►se Ont <br /> Qwnet�s Weli Number MW-1A `t Well �:+Dt1ipfetion )Report oo�°tf1�in <br /> r <br /> Dote Work Megan 05/1412012 r etErt4 tnsrrc+crion t�amo rer <br /> NOe0152897 state tNell Numberlsite Ptumt�r <br /> is Local Permit A Date Work l=aded 5J16t201 <br /> gency Sart �aatrin r'... nvironmen#at N w <br /> Permit fdumber.� latitude i ort nude <br /> ! Perrrli#Date 518/12 --.- <br /> Geo! Ic L APNrCRS/Other <br /> Orientation 0 vertical Q Horizontal <br /> Driffing Method Hollow Stern Au er ©Angle Specify r <br /> Depth from Drilling 8ariofame TCsteFarms, j <br /> Feet to Feet Descrtptlon Palling Address 2460� RI <br /> 28 0 Describe material. rain size;color,etc <br /> csste od <br /> Overdrill removin afi w )l materials, Cit T-Tir c..._r._ <br /> State CA - 953—77 <br /> Well Location - <br />' Aldress 24 t3 Tost Rad <br /> City Trac <br />` County San Joagtrin <br /> Latitude , <br /> „ Crew. Min: Seo: N Longitude <br /> CstumDecimal Lat.Book im g. sec. <br /> , <br /> 1. A't+i "'— Decimal Lgn �� <br /> .t �'1.�.�„� 'Page <br /> Townshi --�_._ Parcef 25 <br /> r Flan a------ Section <br /> Loc <br /> 'Skefch must be d a�wntb hand,af err forrr is. rintea. K <br /> • Activi <br /> North }New Well <br /> 4 Modificat oniRepair <br /> „ 0 Deepen P <br /> O Other;----_ r. <br /> C3 destroy <br /> .. � Oas«"e�ocenra and mega. �. <br /> ,:rider"GEOLOGIC LOG,: <br /> Planned Uses ,. <br /> El Domestic QPubiic <br /> []irrigation <br /> u, Qindt3striai +, <br /> (�Cathndic.>xro#ectiori.: <br /> a <br /> u 0 Dewatering. <br /> !. Q Heat Exchange <br /> .. ... Q injection <br /> 0 Monitoring <br /> Q Remediation <br /> 0 Sparging <br /> South (0 Test Wei[ <br /> 91'!Ce a delivibe cAatenea OF"fl IFM,oads;bv'iIdinp,,fenaa; `�'• Vapor Extraction <br /> atC,dnd gttach a map.VU eddlb"al Pepe,if,necexsary... /"+� <br /> pill ba ifccurate end o ta.. 0 Other <br /> t , <br /> a lertevel and Yield of CdM feted Well <br /> Depth to first water , (weef:below:surface) <br /> Depth to Static .. <br /> Wider Level (Feet} Date Rieasured <br /> Feet <br /> Total Depth of Boring 28 r --- <br /> . Estimated Yield <br /> —(GPM) fest:Type <br /> Total Depth ofCompieted Well 28Fee# Te.it Length (Hours) Total Ora <br /> wdown <br /> deet):: <br /> "Mia not be ra resentative of a well's longterm yietd. <br /> Casin s Annular Material <br /> Depth from Borehole ..r—�_, ... <br /> Surface Diameter Type Materlai Wail CSuteide ScrriBn Siot Size. Depth from <br /> Feet to Feet Inches Thickness Diameter Tyi:@ if Any Surface Fill Description <br /> Inches i. InchesInchesFeet to Feet <br /> .y • <br /> certification Slatetne <br /> ❑Geoioglc Log l the undersigned,Certify that th'� n! <br /> Attaah#eents <br /> Q Well Construction Diagram Naive A!i U ell Abandoments nrport is complete and accurate tp.the best of my krtowledge;and <br /> nbelief <br /> d Geophyslca!Log(8) Person Fkm or corporation <br /> ❑SoiVUVaterChethicaiAna lyses 9245 Be Andresfrve uit r LA0 -._. A 95 <br /> _.._•.:... . 826 <br /> C"1 Other t Map.. Signed .city. yip ------_ <br /> y. �"'"r..i slate <br /> hath additional information,+t k ewsts � c:s7:ll;sensed wafer Wea Ca�taf is .5129120.12 648359 .. <br /> Date Signed .C=57 License Number <br /> DVllirt.i@@ REV:1f2t70@. IFADp1'rIQNA4:SRA E tS NEEDED,USE NEXT CCINSECUTiVEL:Y.NUMBERED FORM. <br />