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*The free Adobe Reader may be used to vista and cramp lis foam,.However.software must be?urchased to complete,()and reuse a saved form. <br /> File Original with DWR State of California l}WR Use On Da Not FS In <br /> Page 7 of 17 Well Completion Report �-- <br /> Refer to Instruefion Pampr at I t t t t <br /> Owner`s Well Number MW-7 No. e0152700 State Well Number/Site Number <br /> � ` <br /> Date Work Began 05/14!2012 pate Work Ended 5L15/16120,12 Latitude�T1 �1 <br /> Local Permit Agency "- t trade <br /> l 1 i r i I� <br /> PermitNumber JNA Permit Date 5f8f12 APNtfRSJpther <br /> Geologic LQ Well Owner <br /> Orientation O Vertical O Horizontat OAngle Specify Mame Taste Fafrtts <br /> Drilling Method Hollow Stam er Drilling Fluid Bentonite mud <br /> Depth from 3urfacq Description Mailing Address 34E's0 Taste Flt ad <br /> Feet lo Feat... Describe materiel, rain size,calor etc C,,.t _State.CA 7i 95377 <br /> d! t) oVerdriil ­­A­ <br /> W611 weCi materials: <br /> Weil Lr cation <br /> Address 2450 T YS t Road <br /> City_Tracy, County San Joaquin <br /> t:ltifude N Longitude y�r <br /> Deq Min. Sec. Pin. Min. Sec. <br /> Datum Decimal Lata ,_dedrnal Lorig;:` <br /> APM Book 238Page 600 _ Parcel 5 <br /> t T•;iwnshi' t2an e: Section <br /> " Location Sketch.*'- Activity <br /> t l$ketchmust hadrawn b hand afterftxrnisor,) Q New Well <br /> North 0 Modi€tcation/Repair <br /> Q Deepen <br /> i O Other <br /> IE Destroy <br /> -- - Deso,ke prme0.eas and materials l <br /> ' Under'GEOLOGIC LOG' <br /> . 'ISlanned Uses <br /> Water Supply <br /> [{ <br />' Domestic ©Public <br /> Lu ❑irrigation' ❑industrial <br />!` O Cathodic Protection <br /> i <br /> O Dewatering <br /> O Heat Exchange <br /> 0 Injection <br /> Monitoring <br /> Q Remediation <br /> a Sparging <br /> South 0 Test Well <br /> . <br /> 171ale or dexribe distance"eii:from reads,bNtdmip,feneee (*•' Vapor Extraction <br /> rNalr.et6.and attach#maP.Use addao0ai paper itnaces4arq_ Q_other: <br /> ... <br /> I Prar,.6 be accume and cam taM.: - . <br /> iter Loveland Yield of"o leted Well <br /> k <br /> Depth to first water <br /> Nfpth to Static (Feet below surface) <br /> j <br /> I Wirier Level (Feet) Date Measured,' <br /> l Total Depth ofBoting .41 Feet Esllmated Yield* (GPM) TesiType <br /> Total Depth of Completed.Wojl:41 Tet;t Length H <br /> Feet (Hours)Total Drawdown...._(Feet): <br /> *M+) not be reproentative of a;well`s.longterm yield, <br /> - Casin s t <br /> tJapth`from Blorehola, Agn.ttlar Matterial <br /> Surface Ofambbor De Material wait t�utaide. Scn Bn' Slot S9xa Depth from <br /> Fant in Feat Thickness ttlarttater Tyi>a ifllny Surface t Fi]f Descrlptlon: <br /> Inches incites Intxhes Feet to Feel <br /> Attacihmetltii.. <br /> Certif(cation Staternght <br /> ❑Geologic Log t t.the undersi ned,certify that this risport is complete and accurate:to the best:of my knowledge and belief <br /> t03 Well construction Diagram Haire All Veil Abando Ment t <br /> I I3 Geophysical Logs) Person.Firm or Corporation ! <br /> D Soil/Water Chemical Analyses 9245 Beatty DriveSuite A �. Sacram%lLa QA 9582 Illi <br /> ..�.. cnr Stated ; <br /> I ©other Site Ma Signed ,12912012 848359 <br /> tiecit additional iMormat on i!itexitMs: •57 Licensed water Well Contr,ctor i <br /> Date Si ned C-57 License Number <br /> C FVR tlt9 REV,1t29Q6 IF ADDITIONAL SPACE IS NEEDED,USE NE;rT CONSECUTIVELY NUMBERED FORM <br />