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'The free Adobe Reader May be used toview enc!0-411(.>85is Ion"'However,software must be purchased to complete, <br /> and reuse a saved Perm. <br /> File Original with DWR - <br /> State of Ca&forni�i <br /> Page ._...� of 7 Weli1 Completion Depart <br /> Ownerow use ant -oa Not „n <br /> `s Well Number MW� 3li+�eterto tr srraron aamprttei <br /> Date Work Began 05/1472012 No: e0152696 state Weill NumberJSite Number <br /> Local Permit Agency San Ir,anr,it Date Work Ended <br /> noir nm ntal h,� tetitude ' <br /> Permit Number —F�--_0 a atr+t X30„ „r tan rtvde <br /> i'errrtit'late 5/8/12 "�-`-�--- <br /> Geolo is Lo APN1TRSlOther J <br /> Orientation C3Verticat J <br /> Drilling Method Hollow Stem Horizontal OAngie Specify, iNell C;Wner <br /> r Drilling Fluid Bentonite rnud Name TvSte FarmS.. r <br /> Dep, frOtn SElrfaoe <br /> Feet to Desarlptlon" hlautng Address 246{}Toste.Fto d <br /> 15 Describe materiel, rain size color etc; t TT Cy <br /> Overdrillremovin allwellrnaterislls. ' State-CA z; 95377 <br />�; ,; W911 t.ocatiart <br /> Address 2_ 450 TRoad <br /> City Trac <br /> e. County San Joaouin <br /> Ll:ltitude N Longitude <br /> 'lea- —'Mtn', Sec.:, <br /> DatumDeR: Min. Sec. 1N <br /> laecimZa#, Decimal Long,_` <br /> . .. Af>N book <br /> 23� page�£?0 Parcel 25 <br /> Tcuvnshi -- Rbn e <br /> -- ..... Section <br /> Location Stretch i <br /> QketM must be drawn is hand atter rrti is �; AcOvi <br /> North New Wetl <br /> 0 Modification/Repair <br /> Q:Deepen <br /> a: <br /> OOntec <br /> 1. C•.oestroy: <br /> . :�. ' :d65ai64 p{iuedues.amtmaieryis <br /> ,.:. Planned:Uses;. <br /> O water Suppf <br /> ,. P4�W16 Y <br /> 4 <br /> See 9"Oti 1710mic <br /> I7 tm anon <br /> u, 9 Cllndustriat <br /> 0 GaMittic Protection <br /> 0.Heat Exchange <br /> tnje to <br /> C'Q:.Monitoring. <br /> Riarriepiiatidrt: <br /> 0 <br /> South t�Test Welt <br /> j h ema oar attach <br /> a mane dtwau ham roads,tahl fings,tar,cea, 0 Vapor.EWc4lo11 <br /> . rirara„ata olx0 attach a reap;Uaa additiaier paper it necexsary. ... <br /> Nbarrrdaaaearat4snd' . <br /> ' � �7 tnh;ar; <br /> aler Level and Viola oft-A. feted Well <br /> Del:th to first Water <br /> Dei:th to Static (Feet below surface) <br /> Tota!Depot of Boltll►g' �}5 - Waler leve! (Feet), Date Measured. <br /> Feet 0 EWsti hated Yield* (SPIN) Test Type <br /> Tota'Depth of Completed Well 15 e Tesi Length <br /> Feet (Hours) Total Drawdown (Feet) <br /> *Mz riot be re resentative of a WeN's tong term yield. <br /> Casings <br /> Depth from Borehole waif Dutslde Scref;n Slot Size Depth from anrteriar Matetai <br /> Surface Diameter Thickness,Diameter T ,. <br /> Feat to Peet Inches Yp if Any Surface Fill Description <br /> Inches Inches, Inches Feet to:Feet <br /> .. ; <br /> Attachments': Certtflcattch Statement I <br /> E3Ceotogic log 1,the undersigned,certify that this re:,ort is completo and <br /> curate to the best of my knowledge and belief <br /> ©well construction Diagram Name All Well Abandonment <br /> 0 Geophysical Log(s) Parson,Finn orCorooration <br /> X24,5 Beatty Drive S a - ratiento <br /> D SolUWater Chemical Analyses --�"..__-..-�—� CA 95$26 . <br /> 0 Other Site Ma ~~- - -�- c lap <br /> Sigrteti ,.. -- 5129 1202 848359 ' <br /> Attach 4ddional Information if it exists, - <br /> C- LI Water WaB Contractor <br /> IF ADDITIONAL SPACE is NEEDED ' <br /> owR,�g REV. Date Si nedRed G-57 t-ieenseNumber <br /> USE NEXT CONSECUTIVELY NUMBERED FORM. <br /> r <br />