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`The free Adobe Reader may used to view and comple farm. However,Software must be purchased to complete,sa d reuse a saved form. <br /> File Original with DWR State of California <br /> Ctl1URAo-Nat Fill In <br /> Page 9 of 17 well Completion Report <br /> Refer,to inStniCtiart Pamphft• �� I t t —t t t <br /> Owner's Well Number OW-2 No, e(1462702 State Weill,Numbertsrte Number <br /> Date Work Began 0511412012 t> Date Work Ended&1612 71 J.__ <br /> Local Permit Agency JsLatitude <br /> Longitude <br /> 1`e !th De�a �t <br /> Permit NumberlY6 Permit Date 518112 APNtTRS/other <br /> t Orientation O VertlCSl 0 Horizontal OAngle YV#i1:Qwner <br /> spec ty Niiime Toste Farms <br /> .' <br /> Drilling Methal Hollow,Stem Auger Drilling Fluid Bentonite mud <br /> S <br /> Depth Description Mallin <br /> ' it fr`orrt ui�tac+3 g Address 2460 Poste i7isad <br /> F`e'et to Feat Describe material,grain size,color etc Cit. Tr cv State CA--zip 95377 <br /> 16 tfOverdrill removing all well materials. YVBII Location <br /> c <br /> Address.29,5010te Road <br /> Ci y Tracy County Sant uin <br /> GalitudeN Longitude <br /> Deq.: MiA. 'Sed: • .baa. �`." <br /> MkL Sec <br /> Oa'tum_* Decimal Lat.._,,,_0ec'rmat Long.. <br /> AFN Book <br /> .238.._ Page :600. Parcel <br /> Townshi` -Range Section <br /> I <br /> Location Sketch Activit. <br /> —lik must be drawn by hand afterfo m.19 printed Q New Well �. <br /> North <br /> Q Modification/Repair <br /> Q Deepen <br /> ` Q Other <br /> Q Destroy <br /> •. Gesaitx procedures anamatef3Ns <br /> under'GE4L9GiC LOG". -- <br /> Flanned t)set <br /> . Water Supply <br /> ' - + 0 Domestic ©Public <br /> [Irrigation 0Industdal: <br /> 0 Cathodic Protection <br /> 0 Dewatering <br /> 0 Heat Exchange <br /> - - Q Injection <br /> 0 Monitoring <br /> Q Remediation <br /> 0 Sparging <br /> South {' Test Well <br /> blued rte or deserttw dstanca of well from roads,buildings.fe+sca.. 0 vapor-Extraction. <br /> Oven etc.sea attach a map,use ad4dionalpaper ittcacessary: 0 Other <br /> .. _ ; Piea�s ba accurafa and cum 4afa... <br /> <: Wailer Laval and Yield of cottz leted Well <br /> Deoth to first water t (Feet below surface) <br /> Deiith'to:Static t <br /> Wa ter Level (Feet) Date Measured. <br /> Total Depth of Boring #6 Feet Estmated Yield"` (GPM) TestType <br /> Total Depth of Conipleled Well Feet Tett Length (Hours)Total Drawdown (Feet) <br /> *Wiy not be re resentative of a well's long term yield. <br /> Casings _ Annular MatMaterial <br /> M _ l 8. (Inches) (inches) l <br /> Depth from Borehole Wail outside Sore:gtt 81ot Slze depth from, <br /> Surface Diamarneter Type Material Thickness Diameter Type It <br /> if Any <br /> Feet <br /> Surface t Fill <br /> Feet Feet e <br /> deacNptton <br /> et to.Feet' <br /> Aitachrtilents211 Certification Sttiltemenk <br /> Geologic Lag I,the undeCsigned,certify that this report is complete and accurate to the best of my knowledge and Abandonment <br /> eII Abe belief <br /> W <br /> Cj WBII Construction Diagram Name All �! <br /> _. <br /> C=Geophysical Log(s) 9245 Beatty Dive Suite A Sacram t CA 95826 <br /> i FrmYdrCorppratlan <br /> C3 Soll/Water Chemical(Analyses Address ci State ftpIZI i <br /> m w. <br /> Other Site Mai Sight d "" - °.-512912(112 848359 <br /> Attach additional information if it exists. C-57 Licensed Water Well Contractor Date Sisned C-57 License Number t .� <br /> bWR 188 REV.112008 IFADDITICINAL SPACE tS NEEDED,USE NE."•T CONSECUTIVELY NUMBERED FORM <br />