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} <br /> *The free Reader maybe used to view and comP <br /> Fite Originalnal with DWR; Ps.­ <br /> -"sfann. However,software must be purchased to complete, and reuse a saved form. <br /> with <br /> State of CBtiforniti DWR use Only C7o Not Fill to <br /> Page of 97 ': W011 Completion Deport <br /> i Owner's Well Number OW-9 <br /> Refer to lnstrt+crlaa tamp,rar <br /> Date Work Began 05/14/21312 No: e0152710 Sitta�te Welt�Numberlona Number <br /> Date Worts Ended �—�L__L Nt D <br /> Local Permit Agency -- Latitude Lo ittx� <br /> Permit Number lVA Permit Date 518112 <br /> APNt7RS10ther <br /> _. C3raotO isLog <br /> Orientation Ca3Verticai �Hortzimtal Weil Owner <br /> Drilling Method HOliaw Stem OADrilling ng Specify Fiuid 0­­­ blame Tc7st8 PBrtTts <br /> - inud <br /> Depth from Surfacet tescrip#ion A'ailing Address 2460 Tanta Read <br /> Feet to Feet Describe material; train size,color,etc <:it Tracy <br /> 16 0 Overdrill removing altwell materials. State CA 71p I377 <br /> Well Loaatlon <br /> t <br /> Address 2450 Tos#e Read <br /> C ty Tracy County San Joaquin 1 <br /> Latitude N Longitude f! <br /> Deo Min. Sec: Dft Mkt. Sec. W i <br /> 0.3ttm Decimal Lat: ,_ Decimal Long: <br /> I AIN Book 3 _ Page Qp Parcel 25 <br /> T iwnshi l2an a Section <br /> Location Sketch; Activity -� <br /> lSkefctt must be drawn by-hand after form is rinled:' <br /> North Q New YVe11 <br /> 0 Modificstian/Repair <br /> Q Deepen <br /> 0 Other. <br /> e)Destroy <br /> 0.0ift pmeadtna and matelots <br /> _ 'aEcuoctcCoa- <br /> ple`ltit'1@4i.11�Fet3 <br /> 0 Water Supply <br /> y ❑Domestic E]Public <br /> <; ❑irrigation Ejlndustrial <br /> s 0 Cathodic Protection <br /> 0 Dewatering <br /> ©Heat Exchange <br /> i Q Injection <br /> 0 Monitoring <br /> a Remediation <br /> a Sparging <br /> South �0 Test Well <br /> lAust'tte or dwIlta distemae 01"0 tram roads,{king,ferccs, Q Vapor F-Wactign <br /> riven:OR,andatsaah a map.Law addihi mat paper if naussary, t'; t?ther.S?zon� <br />' plea is br ac..tataand cam fete. r: <br /> a ter Level'and,YleldofCom fetedWefii <br /> _ <br /> wa <br /> Dedtth to first ter <br /> (Feet below surfac <br /> Depth to Static e) <br /> Total Depth of Boring6 rola ler Level (Feet) Date Measured _ r <br /> . Feet Esijmated Yield' (GPM) Test Type�� <br /> Totai Depth of Completed well 16 Tent Length {Feet} <br /> Feet g ---------_�(Hours)Total Drawdown <br /> *Mt3 not be re resentative of a well's fon term 'etd; <br /> Ca§irt s Annular Mat0dal <br /> Depth from Borehole Watt Outslde Scram Slot Sh 0 Depth from <br /> Surface Diameter Type Mateffai Thickness Diameter Typic' if Any Surface <br /> Feet to Feet finches inches inchesFill Description <br /> Inches Feet to Feet <br /> Attachments <. Certification Statement <br /> Q Geologic Log 1,the undersigned.certify that this re.00rt is complete and accurate to the best of my knowledge and belief <br /> ©Well ConstructionDiagramName All Well Abandonmen <br /> ❑GeophysicalLog(s) Person,Firm or Corporation <br /> 13 Sail/Water Chemical Analyses 9245 Beatty DR Le gAg A -,---- cramentn -CA 95826 <br /> tO Outer Slte Mag Signed " LLQ """" y 5/29/20'!2 $tate 848359 Zip <br /> Attach additions i Lft f It sxists. ; _ C-5fi Li,,ad Water Wet!Gtr:tor <br /> DM 168 REV 1120118 Date Signed C-57 License Number <br /> IF ADDITIONAL SPACE IS NEEDED,USE NEX i CONSECUTIVELY NUMBERED FORM <br /> r <br />