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I <br /> C <br /> 'The free Adobe Reader 0msy be used to view and-come �iis-form. However,software must be purchased to complete;(Jand reuse a saved form. <br /> File Original with DWR <br /> State of California D1NR tJse[Int -1)c Not-Filftn <br /> Page_6 of 17 Well Completion Report <br /> Refer to fnsInvOon Famphtet <br /> Owner's Well Number MW-6 No. e0152699state Well Number/Site Number <br /> Date Work Began 05/14/2012 Date Work Ended 1i/2012 =-1:171:= w } <br /> Latitude Rude J'J <br /> Local Permit Agency ZW JQijauin County n"it nmpnt l Health Q=rfinent � 1 <br /> Permit Number-NA--. Permit Date 51$/12 APNtiRS/t)ther <br /> Geaii `ic <br /> Log UVeEI Owner <br /> Orte on OVertical 0 Horizontal OAngie Specify <br /> M1lame Toste Farms I -... <br /> Drilling Method Hollow Stem Auger Drilling Fluid Sentonite mud <br /> Depth from;5t»fsce Debibriptibin Mailing Address 2460 Toste Road <br /> Feet to ;`Feet Describe material,arain siie color,etc c:jty, Trac Cpl Z. <br /> Skate I96377 <br /> 15 1 Overdrill removing all well materials: iNetl Ltaca#itsn <br /> Address 2450 Toste Read <br /> C ty_TtaGY County San Joaquin _ <br /> tt L:ititude IN Longituft.. _,,,,`yv <br /> t' 000. Min Sec: Deo, Min. Sec <br /> D.tturn-Decimal t at- ...beamai Long <br /> APF/Book Page 600 Parcel .25.: <br /> T:,wnshie Range Section <br /> I r <br /> Location Sketch Activity <br /> . i5ketch mustbe grawn by hand after fott111s: rinted. <br /> d New Well <br /> North <br /> Q ModtficatianlRepstr <br /> Q Deepen. <br /> •Q Other <br /> ?..Destroy.: <br /> beetrbe prosedwee and materials <br /> under GEOLOGICLOG' <br /> r ("' <br /> :Pl�ttirtt�d:tJst'8 . <br /> Q Water <br /> Supply <br /> l 1,,, C]Domestic ❑Public <br /> s; 01itigation I]industrial <br /> Cathodic Ptotectiart. <br /> Q Dewatedrig <br /> 0.i:teet:Exchange. <br /> trtJectitirr <br /> &;Ajton1toring. <br /># >R66ieaiat"iolli <br /> Q Sparging: <br /> Test Well <br /> South <br /> IduaVapor Extraction <br /> 4Afe.W deacnbeArsiance of xmil ham reads,6uildnga,ienCe6. <br /> . . .. - nVbYf,etp,and aftaih a map.Use additional paper it neceaaary. Q Other <br /> ' Pkb`a libbacuratr and c kte. <br /> O t r Level enc#Yleld of Goin leted Well <br /> Depth to first water (Feet below surface) <br /> Depth to Static <br /> Witter Level (Feet) Rate Measured <br /> Total Depth of BbHtSg Feet Es'!mated Yield* (GPM) Test Type <br /> j Total Depth of Completed Web : Te:;.t Length <br /> Feet (Hours <br /> )Total Drawdown (Feet) <br /> not be re resentative of a well's ton term iefd. <br /> Depth from -Borehole Annular Material <br /> Type mawerlal Wall 5oteide Scre:tri Stot Size Depth from <br /> Surface Diameter Thickness Diameter Type if Any Surface r Fill Description <br /> Feet to Feet Inches Inches Inches Inches Feet to Feet, <br /> i <br /> Attachrnnts 1, Gertiflcation Statement <br /> E3Geologic Log 1,the undersigned,certify that#his rcport is complete and accurate to the best of my knowledge and belief <br /> Q Well Construction Diagram Mame All Well Abandonment <br /> Geophysical Log(s) Person Firm or corporation <br /> 9245 Beatty Drive Suite A Sacramento CA 95826 <br /> © <br /> Soil/Water Chemical Analyses Address city s <br /> M tither Site Map Signed'��-•- 5129/2{?12 tate i <br /> �._ �---� <br /> Attach tarsatirttatrnationititexsis -'C- Cteensed aterWell Con ixar Date Sl ned G-57 License Number <br /> DWR i88 REV 112005 " IF ADDITIONAL SPACE IS NEEDED USE NEX,'CONSECUTIVELY NUMBERED FORM <br /> a <br />