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'The free Adobe Reader maybe used to view and comp,,.tis form, However,software must be'purchased to complete,s,,,,,{and,reuse a saved form. <br /> File Original with DWR <br /> State of California <br /> Page 15 _ of 17 Well Completion Report Dvvt�use t�nl _Do Not t ar rn <br /> Owner's Well Number OW-8 Refer roinstruction Pamp'ier <br /> Date Work Began 05114!2012No, eO152709 State Well NumberrSite Number <br /> Local Permit Agency. <br /> bate work Ended 1- t6/ 7 �����—=mssVV <br /> Permit <br /> � ---.-- Latitude Lon etude. <br /> Permit Number�A Permit Date 51$112 <br /> APNtTRS/other <br /> Ueolo le Lo <br /> Orienta#tonO Vertical O Horizontal Well gwner <br /> CDAngle Specify Exams <br /> Drilling Method Hollow Stem Au er fioSte Farms <br /> Drilling Fluid Bentonitemud <br /> Depth from Surface Description N'ailing Address 2460"Taste_Road <br /> Feet to Feet Describe material rain size color,etc C;it Tracy <br /> 16 Q Overdrill removina all well materials. State CA Z, 95377 <br /> We{!Location <br /> A,3dress 2450 ToSte Road <br /> C ty Tracy County San Joaquin <br /> L:rfitude IN Longitude , <br /> Dep. Min. Sea W <br /> Cep.. Min Sac, <br /> DatumDecimal Lat, Decimal Long. <br /> AI'N Book-= Page 5t}p Parcel 25 <br /> T i swriship Range Section <br /> Location Sketch ` Activi <br /> iSketch must be drawn-bydf8wn-by hand after form is printeal <br /> North New Well <br /> {Q Modification/Repair <br /> Q Deepen <br /> d Other. <br /> Q Destroy <br /> Oew*ibeMdcedrwes and materials <br /> under'GEGLOGtC BGG' <br /> Planned Uses <br /> 0 Water Supply <br /> &E t 1 1 oDomestic ❑Public <br /> [Irrigation [3industriat <br /> ui <br /> 0 Cathodic Protection <br /> 0 Dewatering <br /> 0 Heat Exchange <br /> 0 Injection <br /> Q Monitoring <br /> 0 Remediation <br /> 0 Sparging <br /> South /(0 Test Well <br /> iliusb.de or.describe distance of web kdm roads,puild'rnps,fences, `+ Vapor Extraction <br /> 'Ne";etc:and attach a map.Use additional paper it necessery,. ^y <br /> Rom bs.odwrace.nd com Mt:.. {..!Other Ozone <br /> aier Level and Yield of Completed Well <br /> Depth to first water (Feet below surface) <br /> Depth toStatic <br /> Waler Level (Feet) Date Measured <br /> Total Depth of Boring 16 <br /> Feet Est mated Yield* (GPM) Test Type <br /> Total Depth of Completed Well 16 Tee'Length <br /> .Feet (Hours) Total Drawdown (Feet) <br /> 'Mp not be re resemotive of a well's ion term ietd; <br /> Gastn s ar M <br /> Depot from Borehole AnnulaterlatWall Outside S YP'n Slot <br /> Anza _ ..�" ' .�., <br /> Surface Diameter Type Material Depth from <br /> Thickness Diameter T it Fill Description <br /> Feet to peat Inches Inches Inches s Baro F ptian <br /> Inches Feet to Feet <br /> Attachments <br /> Certification:Statement. <br /> ❑Geologic Log 1,the undersigned,certify that this report is complete and accurate to the best of my knowledge and belief <br /> 17 Well Construction Diagram Name All Well Abandonment <br /> ❑ Geophysical Log(s) Person,Firm or Corporation <br /> E3Soil/Water Chemical Analyses U245— be--" rive <br /> ttv riv eHutto A� _ Sacramento CA 95$2$ <br /> ss <br /> Other Site:MaQ Signed —~ – stag zp <br /> ._ �_ <br /> x/2912012 84$359 <br /> Attadt additibnai IrHormation if it exists. LIc ater Well Contrac�or —"` <br /> DYM 188 RE trrzoot3 Date Signed C-57 License Number <br /> IF ADDITIONAL SPACE IS NEEDED,USE NEXt CONSECUTIVELY NUMBERED FORM <br />