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'The free Adobe Reader may be used to view and complete this form. However,software must be purchased to complete,save,and reuse a saved form. <br /> File Original with DWR State of California DWR.Use Onl =DO No4Fill In <br /> Page of Well Completion Report <br /> Refer to Instruction Pamphlet State Welt Number/Site Number <br /> { rs Well Number No. e059871 <br /> ork Began 1 4 08 Date Work Ended Latitude Lon nude <br /> Local Permit Agency_ aft�iOaQUin Co. Healt ell U Dt <br /> Permit Number 5IDZ Permit Dale APNRRS/Other <br /> Geologic Log _Well Owner <br /> Orientation OVertical 0Horizontal OAngle Specify <br /> Drilling Method mild rntAry Drilling Fluitl <br /> Depth from Surface Description <br /> Feet tc Feet Describe material,grain size color,etc <br /> 20 C l a Well Location. <br /> b % clay Address Same <br /> blue sand City countV$do Joaquin <br /> blue c a Latitude N Longitude17 _ Mi_�v <br /> blue san Dee, Min. Sec. Deo. n. Sec. <br /> blue clay Datum Decimal Lat. Decimal Long. <br /> San ravel APN Book _ Page 280 Parcel na- <br /> b Ue clay Township —Range Section <br /> San Ipravel Location O'ch .°ActiVit`.. <br /> 160 175san DI'.A streaks '(Sketch must be drawn ti ftan'datler IL ie..'nted. XQD <br /> New Well <br /> San ravel North O Modification/Repair 185 O Deepen <br /> clay blue OOther <br /> sand/gravel sand/gravel O Destroy <br /> blue clay uon.d°m EOLDOIC LOW m.led.I° <br /> 2316— San rave •'. PlarinedL1ses= ' <br /> blue clay 0 Water Supply <br /> San ravel t]Domestic []Public <br /> w ❑Irrigation ❑Industrial <br /> blue clay 3 O Cathodic Protection <br /> A sand ravel 0Dewatering <br /> L blue clay O Heat Exchange <br /> C a 0Injection <br /> —Flue clay O Monitoring <br /> clay/shale O Remediation <br /> sand/clay streaks O Sparging <br /> clay/shale South O Test Well <br /> O Vapor Extraction <br /> sand41-645 clay "aee'�' a:U':�;�wa„ pa "K 'm OOther <br /> c a 645- 4 PI. °a.0 ra...,.� .d. <br /> San 647-648 rock ater.Lebetand•Yteldof Completed Welh <br /> c a - sandDepth to first water (Feet below surface) <br /> Sand 650— Depth to Static <br /> Water Level 37 t (Feet) Date Measured <br /> Tol/a Depth of Boring 655 Feel Estimated Veld` (GPM) Test Type <br /> Total Depth of Completed Well 460 Feet Test Length (Hours) Total Drawdown_(Feet) <br /> *May not be representative of a well's long term yield. <br /> Casings •,;;'Annular Material = <br /> Depth from Borehole Wall Outside Screen Slot Size Depth from <br /> Surface Diameter Type Material Thickness Diameter Type If Any Surface FIII Descrlption <br /> Feet to Feet Inches Inches Inches Inches Feet to Feet <br /> an 0 100 ik rout <br /> 0 0 8 sand & <br /> gravel <br /> Attachments Certificatioh'Statement <br /> Geologic Log I,the undersigned,cerliryry that this report is complete and accurate to the best of my knowledge and belief <br /> Well Construction Diagram Name HENNINGS BROSt DRILLING CO.. INC. <br /> Geophysical Log(s) Per on,Firm or Corporation <br /> Pel'a d le Av . Modesto CA 95356-9781 <br /> ❑ SoilfWater Chemical Analyses Add sa state Zip <br /> ❑ Other Signed cay 1 28 08 290813 <br /> Atom additional inforoneu it it C-51OLidtosioi water wall coma 41 Date Signed C-57 License Number <br /> DWR 188 REV.Incas IF AODITIONALSPACE NEEDED,USE NE CONSECUTIVEL N MSEREDFORM <br />