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,t <br /> 'The free Adobe Reader may be used to view and cc '� j� <br /> g ars Ilam. However,software must be)urchased to complete,j,,, and reuse;a<saved form. <br /> File Original with DWR y <br /> State of California DWR Use On -po Not Fill in i <br /> Page 2 of 17 Well Completion Report <br /> t7wner's Well Number MW-1 B Peterro instruction pamptaet C <br /> ' iNo, e015269$ State Welt Numbed Site Number <br />` Date Work Began 0&1 12 Date Work Ended 511612012 -t— N <br /> Local Permit Agency Sart Joaauin Cg&nty nviror5fie tai t i- '*�t D Latitude Longitude <br /> Permit Number --fLwt t i i <br /> Permit Date 51811 <br /> APNr'TRS!Other <br /> 09010 is Lo' <br /> Orientation ,4&V#rti Horizontal OAngle Specify�� � Welt Owner <br /> Dt4ttinp;Method C toltaw Stem A..--- Drilling Fluid Bentonite mud home tOStG' rnt5 <br /> bepth•frarn Surface Description fviailing Address_2460 ToSte Road <br /> Feet F6et. Deseribe materiat, rain size,color etc Cit Tracy tt <br /> 15 ... C?verdrll remavin all well materials, t State �ip 95377 <br /> Will Location <br />!' Aildress :242 Tt ste Road <br /> city TYacv <br /> County.Sart Joaquin <br /> Li:fitude :N Longitudar _,� <br /> _ •. . rein:" gee's <br /> Doo •—•-S� <br /> j 17sa:. Mit+, sec:. <br /> Diitum <br /> Pima[Lat.— ClesimaILong. <br /> AEON Book, _.. Page fl � Parcel ..26 <br /> Tt�wnshi Range. Section <br /> Location Sketch A <br /> ctivity. <br /> ,E; <<�Icstch must drawn b nand attartomi is nnit�:'. (' ll <br /> North <br /> 0 Modification/Repair <br /> en <br /> y <br /> r <br /> :611is?, <br /> p, cedurn mqi matedahOt4tpG'- __ett,tJses <br /> S(�e flffi0 Water Supply <br /> �1 ❑Domestic [,3 Public <br /> J1 Q1rr`igation ❑industnar <br /> a <br /> Q Cathodic Protection <br /> Q Dewatering <br /> 0 heat Exchange <br /> 0 Injection <br /> (D Monitoring <br /> 0 Remediation <br /> 0 Sparging <br /> South 0 Test well <br /> e. tNust'rte ar deacriae diatanca of watt*Q.roads.Wodtnpa;leacea, `� Valor Extraction ` <br /> �- IiMl-aid.and apach a mak•ttsa ddditionel prrPer ii nedessary. ( _(}their <br /> Pie*to baaCdurata and:eunf req,. - ,f <br /> a,ter Levet and field of Corn .letecl Vifell <br /> Death to first water <br /> '' Depth to Static (Feet below surface) <br /> Ws*Level (Feet). Date measured_ <br /> Total Depth of Boring 15 Feet Estimated Yield• t <br /> .�. (GPM) Test Type <br /> Total Depth of-Completed Well 15 Tetit Length ' <br /> _ f=eet (Hours}Total Drawdown (Feet) <br /> •Mt not be re resentative of s well's ton term ¢tib; <br /> Casin s <br /> Deptl#iram Bol'ehota Annular Malterial <br /> Watt Outside scretYn Slot Size pepth from M. <br /> Sumacs blemater Material. Thickness Diameter. Type If Any Surface Fill <br /> Feet to Feet inches Inches inches Inches Fest' to Feet- Description <br /> Attachments <br /> Certification Statement <br /> 0Geologic Log i,the undersigned,certify that this report is complete and accurate to the best of my knowledge and belief <br /> O Well Construction Diagram Mame At Wet!Abandctitment <br /> 171 Geophysical Log(s) Person Firm or Cc=istion <br /> 24 a Drive Suite A <br /> Sacramento CA; 95826 <br /> ❑Soi[tWater Chemical Analyses Addres "— _ <br /> C:7 Other Site Maty Signed r - — � 5JZ912(}12 iatia _ A <br /> Attach additional inirrmf iii#eld8ta G-5 L tensed Water Wei Contra:for <br /> DWR 188 REV,1/2006 Date Sig ned C-57 License Number <br /> IF ADDITIONAL SPACEIS NEEDED,USE NEX i':CONS EC1JTiVELY NUMBERED:FORM -- - - 1 <br />