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State of Califomia <br /> Well Completion Report <br /> Form DWR 188 Submitted 4/30/2018 <br /> WCR2018-003403 <br /> Owners Well Number Date Work Began 01/23/2018 Date Work Ended 01125/2018 <br /> Local Permit Agency San Joaquin County Envlronmental Health Department <br /> Secondary Permit Agency Permit Number 37828 Permit Date 01/19/2018 <br /> Well Owner(must remain confidential pursuant to WaterCode 13752) Former Use <br /> Name FERGUSON FIRE/FAB, Activity Destroy <br /> Mailing Address 1600 W.Linne Rd. Fortner Use Water Supply <br /> City Tracy State CA Zip 95377 <br /> Well Location <br /> Address 1600 W Linne RD APN 253-110-03 <br /> City Tracy Zip 95377 County San Joaquin Township <br /> Latitude N Longitude W Range <br /> Section <br /> Deg. Min. Sec. Deg. Min. Sec. <br /> Baseline Meridian <br /> Dec.Lat. Dec.Long. Ground Surface Elevation <br /> Vertical Datum Horizontal Datum WGS84 Elevation Accuracy <br /> Location Accuracy Location Determination Method Elevation Determination Method <br /> Bordhole.Information Water'Level and Yield of Completed'Well <br /> Orientation Vertical Specify Depth to first water (Feet below surface) <br /> Dolling Method Drilling Fluid Depth to Static <br /> Water Level (Feet) Date Measured <br /> Total Depth of Boring Feel Estimated Yield' (GPM) Test Type <br /> Test Length (Hours) Total Drawdown (feet) <br /> Total Depth of Completed Well 126 Feel `May not be representative of a well's long term yield. <br /> Destruction Details: <br /> Pulled existing pump.Pumped bentonite(quik grout)from the bottom to the top.Came back the next day,cut off casing 4' <br /> topped off with hole plug and cement. <br /> Other Observations: <br /> RECEIVED <br /> AUG 2 7 2018 <br /> ENVIRUNMEN rAL HEALTH <br /> DEPARTMENT <br /> Form DWR 188 rev. 12/19/2017 Page 1 of-2- <br />