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'The free Adobe Reader may be used to view and com fi k` <br /> els iorrn: tiawever, <br /> Fite Original with DWR software must bu purchased to complete,Uand reuse a saved Tari <br /> State of Calffoml•: <br /> Page 4 of 17Well Ct3trtpletion (Report :Dw _use DaJill III FF�(,� <br /> Owner's Well Number (UlW-4 Reread tnsrrrrcxo„pamvtrIar , <br /> t' Date Work Began 05114121112 No. e0152697 t---a--testa—to-welll Numberli Numtwr <br /> bate Work Ended � L-t —t--�"—I W <br /> Local Permit Agency <br /> I- g }dl c�ttnty Envirartmen#^�}is al+h CJ o r#m r,r pude <br /> Permit Number iA Latitude Lo <br /> Permit Date 51811— 2�- � '®— �-- i <br /> �ieti(tS IG LonAPNtroeiOt _ # <br /> Orientation C)Vertical O Horizoiitat Wei(Qwner <br /> Drilling Method Hollow Stem A er 1 ling S <br /> pecify fame Toste Farms <br /> Drilling Ftuld mud <br /> Depth from Surface <br /> Feet to Desariptiorr Mailing Address 2460 ToSte:Road <br /> Feet Descr#se materiat, rain size,colt:It <br /> 15 0 , Tracv <br /> Overdrill removin all well materials. .. State CA Zi 95377 <br /> Well Location <br /> I A:idress 2450 Ttaste road ) <br /> C.i#y Ti <br /> .County San Joaquin <br /> Latitude iV Longltuvle <br /> t7ecf. M r. ,.�..3N .. <br /> Sec t]en Mint; <br /> Gatum Decimal Lat. <br /> .: •. -•---,.._Decimal Long.. <br /> AIN Book 238 Page Parcel 25 <br /> Tllwnshi Ran e Section <br /> Location Sketch? Activity <br /> {Skafch must betlrawn b hand after forrh is ed: <br /> North aJety Well <br /> •;.. Q:MtrdtificationtRepafr <br /> '. 0 Deepen <br /> to tither <br /> DeStt0y <br /> .oftate PrOceduraa end maw <br /> `ec-a:acic Lab' <br /> ..�., Planned Uses <br /> a Water Supply <br /> i [,100mestic:.QPublic <br /> a: Dtrrigetion :�Jindustrial <br /> Q:dathodiG:P:roteetion <br /> • ., �t)ewatering <br /> .i O Heat Exchangie y <br /> O injection: <br /> O Monttod ig <br /> 0,0emadiatiion <br /> p P� <br /> .P.: .Q.°Sparging <br /> South lest: <br /> ,0/ry <br /> . 1#00 ft or describe dfstanca of welt ham 1 buirdFrvep:ienoee,. 1J V0,00�ExtratalOn <br /> .. ri.ate,and afti a map.the addidonat paper It ire .. ... <br /> . .. 3f Metlir 6ea11un4:arMd hb;. cea6ary. 4I t�ther__ <br /> a <br /> For Llavw a'rjd Y(e(d of Cann leted tNel( <br /> Death to first water (Feet below suface). <br /> De;dhto Static <br /> Wa:er Level <br /> Total Depth of Billing1.5. .(Foal) Date Measured <br /> a 1 <br /> Estimated Yield (GPM} Test Type <br /> Total Depth of Completed Welf 15: Test Length <br /> Feet (Flours) Total Drawdown (Feet) <br /> 'Mtnnot be re resentative of a wail"s Ion term.field: <br /> 1;aSit1 S • <br /> Depth from 9trtehale Wali Outside ScreE"ir Slot Slxe Depth from; Altnular Material <br /> Surface Diameter: type Material Thickness Diameter T u <br /> Feel to Feet inches inches Inches Yp If A:ny Surfat l} r. Flit Description <br /> If <br /> Deet to Feet <br /> AttachmeirttS.. <br /> ElGeota Ic Lo Certification Statemerft i <br /> g g t"ttte undersigned,certify that this repon is complete and accurate to the best of my kn <br /> ❑Well Construction Diagram Name ll Well Abandonmt?nt owledge and.beiief <br /> Q Geophy akAl Logs) Person Finn or corporation E• <br /> ❑Soff/ ter Chemical Analyses 9245 Beatty C ,— ` --- Sacra--- me—nto 44 CA 95826 i <br /> 0 Other Site Ma Signed ''-_ city sta,a ja. <br /> Attactr eddiNonati formation Ef it a>Asts. C 5f ticonsed water MR Cc itrec:or 2� 848359 .1 <br /> DWR 188 REV:WOOS tF:AWT.;ONAL SPACE t$NrzEDE D,USE NEX"CONSECUTIVELY NUMBERED aFORM'te Signed C-57 License tlUmtSer <br /> a <br /> i <br /> tin.... .. <br />