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'The free Adobe Reader Maybe used to viewand compleufomt. However,software must be purchased to complete,sand reuse a saved form. <br /> File Original with DWR State of Californiat D4VR Use<3nltFill in <br /> Page 22 of 2 'Well.Completion Report <br /> Refer to <br /> tnstdon paphkOwner's Well Number MW State r Well f NumbeNSi <br /> t Number <br /> . eD152714 <br /> Date Work Began 05194/2012 Date Work Ended 5/t6t2QJ2 Ell- 1— <br /> l ?�l ���- <br /> .— atitude Lon nude <br /> Local Permit Agency San JDaauin vnty EnArOfthak6tall wealth DODarlMant � <br /> Permit Number NA Permit Date 5/8112 � r ' <br /> APNti'RSJOther <br /> Glo is Lo <br /> Welt Owner i <br /> orientation QVertscat O.Horizontal 0kngle Specify Nnme_Tt7ste Farms' , <br /> Drilling Method Hollow'Slot"Auger Drilling Fluid Bentonite mud 1 <br /> 113 0, fe*m•Surfae6_ Description M.-idling Address 2460 Toste Road t <br /> Feet to. Fest Describe material, rain size,color,etc cli 7raCyState_A Zi 95377 <br /> t5 0 overdeliti removing all well matedals: <br /> WeII Lcttion <br /> Address 2450 Toste Road <br /> Coy Traev County'SanJoagttin <br /> i -.... Leditude v Lon9 <br /> nude . <br /> vDealam Min. <br /> D;Runl—Decimal La#: becirnaf Long, <br /> i; AFIN Book 238 Page 600 Parcel M. <br /> ;.. Townsht Ran £. ...�., Section <br /> t <br /> Location Sketchganleg, Activity, <br /> :. <br /> ; Skslch mast be drawn,by hand after.fod <br /> New Well <br /> 4 North0 Modification/Repair <br /> 0 Deepen <br /> 0 Other <br /> [estray <br /> ..,..-- - tDembe gacedwen and mMadals <br /> udder'GEOLO&CLOW <br /> Planned Cues <br /> ( a Water Supply <br /> N � V [3Domestic [/Public <br /> ©Irrigation ❑Industr'ial <br /> Q Cathodic Protection <br /> Q Dewatering <br /> 0 Heat Exchange <br /> 0 injection <br /> d Monitoring <br /> 0 Remediation <br /> Q Sparging <br /> South ©Test Well <br /> UW Idett adesciht distance at wtU dam Coeds,isuifdinps,fence, Q Vapor Extraction <br /> - <br /> rist a,etc:and attach a map,Use addilanai paptr fYn esaary, 0 other <br /> . Phase be acw me add Cam left. <br /> Cter C.evel and Yield of Com ieted Well <br /> D:tpth to first water. (Feet below surface). i <br /> Dapth to Static <br /> Water Levet (Feet) Date.Measured <br /> Total Depth of Elioilifig 15 deet E mated Yield <br /> ,...,�...�_(GPM) Test TYAe.. <br /> Tolst Length (Hours) Total Drawdown (Feet) <br /> Total Depth of Completed Well' 15` Feet Ls!lay not be representative of a well's long term yield. <br /> Casings I Annular Material <br /> l pth,from Borehole Wall Outside Scieen slot size Depth from <br /> Type too rial. <br /> SurfaceDldHtefar. .Thickness Diameter. Tope if Any: ::Surface: Fill Description <br /> Feet to Feet Incheri ..';Inches inches' Inches Feet to Feer <br /> Attachfnents Certification Statement <br /> ®Weill gic Log <br /> Diagram 1,the unde��n i rm rtoe that this report is complete and accurate to the best of my knowledge and belief <br /> g g Name 611 Well Aband nment <br /> rpOraSion <br /> Q Geophysical Log(s) 9245 Beatty Qny2 Suite A Sacramento CA 85826 <br /> Ci soiiiWaterChemicatAnclyse§ "`'� •- �.......�',� v ¢ <br /> Adds Gt State Zi <br /> D other Site Map Signed .,,._._5120/2012 848359 <br /> t=Jg0rall onnatlM It it exists C-57 Ucensed Water Well Cor;r Date Si ned C-57 License Number <br /> 0WR 188 REV,112006 'IF ADDITIONAL SPACE IS NEEDED,USE KI_XT CONSECUTIVELY NUMBERED FORM <br />