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The free Adobe Reader maybe used to view and oompfe form However,software must be F•.rrchased to complete,sd reuse a saved form. <br /> File Original with DWR <br /> State of California 0WR.I fsa A -Do K1— <br /> Page <br /> Page I -- of 2. Well Completion Report � 1 - - �— t <br /> Ch�tner's Well Number Refer to rnstndro t Psmph&;t State Well Numbet9sde Number <br /> Date Work Began 05/14/2012 No e0152713 <br /> g Date Work-Ended 115I20 2 l_.:N r i i r w <br /> Local Permit Agency .tDaa in -+�+ ti Envi r,r^� u �^y Lan-nude <br /> tft C«rame Health QaogaMQa-­_ <br /> Permit Number_NA Permit Date 5/8/12 ARNrrRsrther. <br /> t Geolo lc Lo Went t3wner <br /> Orientation: @Vertical QHorizontal OAngle Specify <br /> E Drilling Method Hollow Stem A erW'me TOSte Farm.- <br /> Dnleng Fluid 8entanite mud <br /> Depth from stirfac;3 '` DrasCriptton Mstiling Address 2460 Toste Rroad <br /> Feat•, to Feat Descr�ematerial rein size,rotor,etc Cil _TraCY state �i 95377 <br /> 28 0 0verdrill renmovin" all well materials. <br /> 1Ne11 Location <br /> Address _.245 0 TostA Road r <br /> E <br /> Cly_Tracy , Geon San Joaquin <br /> �':_ .� <br /> La thude N Lot#gttude <br /> Des Min.: See. Mh Se <br /> c. <br /> Diltum De#mat kat: De+ftnat zcng, <br /> AFM Book 238 Page&M Parcel �3 <br /> Tctwnstil Ba tt. section <br /> 1 <br /> Locatlob 8ketdh VActiv <br /> .. 03ketoh must be drawn .Rand after fan11 i6 ntYed. <br /> North New Well <br /> 0.modification/Repair <br /> O Deepen <br /> s <br /> ,I. IR.Destroy: <br /> . .. ... "` .. ga$iriba Mu2edwet and matedaN <br /> under'GEOLOGIC Loc` <br /> y Planned Uses <br /> (�Weter Supply <br /> �s Ddrde C C]Public <br /> 0.1n lgatlon. .(]industrial <br /> Q Catfiodic::ProteCtion <br /> C :Dewatering <br /> 0.Heat;>Exchange <br /> Initclion <br /> • <br /> }RemiWIo ion <br /> 0 uspargl% <br /> South Test Well <br /> h <br /> ai .... rHust`atoofdaaorlbedlatericearwxttfrom rdada•buildnoi,}teei,: �+!Vapor.Extt'aciitSn <br /> rNeu:,att'aed attach a map.Usa additions(paper iftecasraty, 0 Other <br /> ..... piee�ra be accurate and aam Tata: <br /> filter Leval and Yield of Cdrn letad Well <br /> Depth to first water t' (Feet belgw surface) <br /> Depth to Static <br /> Water Level (Feet) Date Measured:. <br /> Total Depth of Boring 28 Feet E rmated Yield <br /> (GPM) Test Type <br /> Total Depth of Completed wait 28 t. Fleet Te 5t Length (Hours) Total Drawdown (Feet) <br /> ,N By not be representative of a well's longterm field. <br /> Casings ° Annular Material <br /> Depth from BarehOle T Material Wall Outside Scriren Slat size Depth from <br /> surface Diameter � Thickness Diameter Type If Any Surface . Fill Description <br /> Feet to Feet Inches Inches inches inchas Feet to Feet <br /> Attaclitrtan#s' i Cartifit atloh Statempot <br /> ©Geologic Log 1,the undersigned,certify that this report is complete and,accurate to the bast of my knowledge and belief <br /> Well Construction Diagram Name All Well Abandonment <br /> Person Firrn or Corporation <br /> 171 Geophysical Log(s) 9245 Beatty Drive'Suite Sacramento CA 9582§ <br /> ©Soll/Water Chemical Analyses Add t W~�^�� city state <br /> Cl �p <br /> Other Site May Signed -- -. �;�,..... --a 5/29/2012 848359 <br /> Attach additional information nit exists C 57 licens ser e11ConVactor �� Date Si ned C T License Number <br /> DWR tab REV,1r2406 IF ADDITIONAL SPACEJS NEEDED,USE NE KT CONSECUTIVELY NUMBERED FORM <br /> I <br /> i <br />