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I y <br /> 'The free Adobe Reader lata [ used to stew ancE curt is to <br /> However,software must be purchased to complete; <br /> Fite Original wDWR and reuse a saved form. <br /> hit <br /> State of Califomit' V DWR Use On —Do Not Fin In <br />` Page 8 of 17 Well Completion Report <br />' OwnerTs Well Number ow-'I Refer to instruction Pamphlet } � <br /> No. e0152701 State V1fmlt Plumberlone Number <br /> Date Work Began 05114/2912 Date Work Ended-511f212)12 _ a _J N i J® <br /> Local Permit Agency SanJgAgUin <br /> Environm.ntal H alth D Latitude <br /> Permit Number.UA ----- -- i <br /> Permit Date 518112 APNffRsrOther <br /> a <br /> G@OI IC;D, <br /> Orianta#ion Ovettica! t HorizonWep Owner <br /> aAing Specify Nance TCySte Farms <br /> Driging Method Hollow Stem r SDrilling Fluid bentonite_mud <br /> DFeet4 from Surface — Mailing Address 2460 Taste Rnad <br /> Feet to Feet rtp IonDescribe in size,cotta-etc Cit Trac State CA <br /> 16 0 dvertlril€removin all wet!materials. i �-- <br /> Welt Location <br /> Addressr:42O Toste t2taad <br /> city r County.San Joaquin <br /> Latitude <br /> —•—.,. N Longitude <br /> Dea. Minn: Sec. ���^�—•W <br /> Dmtt Mit. Sac: <br /> Datum <br /> ' Dedma!Lat, l�ecin7al iong•�` <br /> t: k3 <br /> A1N Boo <br /> •. .. �U_ Page tDt} Parcel .2a ... :. <br /> Tt;i4vnshi Ran e <br /> Section <br /> Location Skafth i <br /> Activity <br /> .. ..: sSketch mustfte drawn b it8nd after tWYtt iS. Med: <br /> North f New—well--� 0 MbdificatlontRepair <br /> R. Q Deepen <br /> i. f;7 Other.. <br /> Destroy <br /> . r. ..-. urdeiGEOLOGIC LOG'materata <br /> . Planned Uses <br /> . 0 Water Supply <br /> 2. (].Domestte.[Jteubiic <br /> - <; - � L7:1Prigation. :�tndusirtat <br /> Q Cathodic Protedldh <br /> Q Dewatering <br /> Q Heat Exchange: <br /> Q Injection <br /> 0 Monitoring <br /> 0 Remediation <br /> 0 Sparging <br /> South 0 Test Well, <br /> aiusYrata a deartlha dniarvCa of welt tam raada.rwild�nga;tarwea, 0 Vapor Extracts l6h. . <br /> /^� <br /> Not,: *Ad ttaaatldiacnalpaperifnecaaaary. W t}ttlet O ne- <br /> .. � Vlaace be accurate and tam tato..... �{r <br /> WitterLevel and Yield of Cdrrt feted Wdl€ <br /> Depth to first water I (Feet below surface) <br /> Depth to Static <br /> Witter Level (Feet) Date Measured <br /> Total Depth of Boring 16 Feet Es,Jrnated Yield* (GPM) Test Type _ <br /> Total Depth of Completed Well 16Te•;t L _(Feet) <br /> Feet Length {Hours) Total Drawdown <br /> M<t nal be re resentative of a well's Ion' term `eld. <br /> i= Gash s Annular r Material <br /> Depth trent Diameter Walt Outside Scre',rn Slot Size Depth from <br /> Surface F Diameter Typo Mateeiat Thickness Diameter Tyra if Any Surfaca Fill Feint to Faint Inches incises Inches Inches Feet to Feet Description <br /> �.El Cdetificat€on 5tatemartt <br /> ©WellConstructionD` g l <br /> Attachniettts. <br /> Geologic g Diagram Nme1.the U Ail under—signed, <br /> Aryan certify that this nsport is cerrnpiefe and accurate to the'bestofmy knowledge and belief I'I <br /> t�f g - onment <br /> u Geophysical Log(s) Person,Firm or corporation 3 ' <br /> D Soll/Water Chemical;Analyses 9245 Beatty Dridv eSuite A Sacramento CA 5826 <br /> 0 Other—Site Map Signed 5/29/2012 $48359 <br /> Attach additional tnrontiation if it exists, s^ �C-67 Licensed water Wel,Contractor <br /> DWR las REV.tl2006 Date Signed C-57 license Number <br /> tFAt]LiiTtONAL SPACE IS NEEDED,USE NEX"CONSECUTWELY NUMBERED FORM i <br />