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"The free Adobe Reader may to used to view and oomiplN,,,is form. However,software must be purchased,to complete,s,, nd reuse a saved form. <br /> i Fite Original with DWR State of California sDWR Use Only-Do Not FllGln <br /> j Page of 17 Will Completion Fiteport <br /> Refer to Instruction Pemphh t:. State Welf Number/Site Number <br /> Owner's Vifeit Number MW-5 No. eOI52698 -1 N w <br /> Date Work Began 05114/2012 Date Work Ended 5/1612012 Latitude Longitude <br /> Local PermitAgency , <br /> Permit Number'NA Permit Date 5/8/12 atPNt f RStC)tner <br />' .. <br /> WerU a ._ r <br /> owner <br /> i Orientation 4Verticat q.Horizontat OAngle Specify Name Toste Farms <br /> Drilling Method Hollow Stem Auger t3nlimg Fluid :$entonite mud <br /> Mailing Address 2460 TOSte t r5ad <br /> Depth from Surface Description <br /> Feet to Feet Describe material,grain size,color:etc C-,,% Tracy State Dpi 95377' <br /> 15 0 Overdidli.renn6ving all well materials: Well Location <br /> Ac dress 2450 Toste Road <br /> Gi-y Tracy Courttp: San.Jaaquin <br /> t LatitudeN Longitude <br /> 5; Deo. Min ' Sec. I. Oeq. Min. See <br /> D,itum_ Decimaltat:,, Oocimal#tong. <br /> APN Book238 Page 660 Parcel .25 <br /> Township Range Section <br /> I <br /> Location Sketch Activl <br /> ,,Ketch must*drawn tf hand alter fo ':is Tinted: 0 New V011 <br /> North <br /> 0 Mo¢PfibOWWRepair <br /> +C)I7reep�eii <br /> 06mor <br /> Wools* <br />. ; oer«ee me«aTars ana maeenan <br /> �;; .under`GEQI:OGIC lG1G' <br /> __-Manned Uses. <br /> tUt a Water Supply <br /> [QDomestic QPublic <br /> t, <br /> w C3 Irrigation [Industrial <br /> 0 Cathodic Protection <br /> 0 Dewatering <br /> d Heat Exchange <br /> 0 Injection <br /> Q Monitoring <br /> 0 Remediation <br /> 0 Spavin$ <br /> South O fest Well <br /> 11IualVto ordnWhe distance of wet)from made;b0dinp,iencea, Vapor Extraction <br /> e..c,etc.and attach a mappthelat aGtFaonat paper if neceaaary: Other <br /> pl <br /> : - Ptanre6eaccurataanacom tete, <br /> lister Levei;and Yield of Coati feted Weil` . <br /> Depth to first water (Feet below surface) <br /> - Delpth to Static <br /> Writer level (Feet) Date Measured <br /> Total Depth of Boring 5 Feet Es:imated Yield' (GPM) Test Type <br /> Total Depth of Completed Well 15 Feet: Te.>t Length (Hours)Total Drawdown (Feat) <br /> 'N,a not be re resentative of a weirs Ion term lead: <br /> I <br /> Casio s Annular Material. <br /> Depth from Borehole Wall Outside Seri+en Slot Size Depth from <br /> T Material Thickness Diameter TyAd <br /> Surface Dlatnater lia if Any Surface Fill Description <br /> a Feet to Peet (inches) <br /> inches. inches inches Feet to Feet <br /> r©mit2lchments IF . _ Certificatfort:$ta <br /> eafe otemsnt <br /> lag ere un-dersigneldi,oa tify that this eport is complete and accurate to the best of my knowledge and belief <br /> C3 Well Construction Diagram Name All Well A idon tint <br /> Person,Firm or Corporation ..... <br /> E3 Geophysical Log(s) 9245 Beatty Drive Suite ASacramento CA.. :95$26 <br /> G Soil/Water Chemical Analyses Add . ,.r~,.+..---c� state zip. <br /> M Other_Site Map Signed �. - w..-�'"" 5/29/2012 $48359 <br /> Raachaddltlonat,Mormation,!Iittxis "= C-5 'rcensedweterWeilcont�ador t',)att3:SI ned C-SiLicertSe-Number <br /> DWR 188 REV,1r200s lF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />