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the free Adobe Reader may be used to view and comple�form. However,softwaf <br /> us po s d reuse a saved farm. <br /> File Original with DWR State of DWR Use Onl —Do Not Fill In <br /> Pae 1 of 1 Well Complon eport <br /> Page Refer to Instruction Pamp ❑❑ <br /> Owner's Well Number MW-13 19 1 9 20 5 State Well Number/Site Number <br /> No. e0252471 N w <br /> Date Work Began 01/22/2015 Date Work Ended 1/22/2015 Latitude Longitude <br /> Local Permit Agency San Joaguin County Environmental Health D artm <br /> Permit Number SR#71308 Permit Date 1/7/15hN APN/TRS/Other <br /> Geologic Lo W1T/Cq;FRV1 E- Well Owner <br /> Orientation O Vertical O Horizontal OAngle specify Name Peter Bui and Kimberly Hoang <br /> Drilling Method Hollow Stem Auger Drilling Fluid Mailing Address 4004 Maddie Circle <br /> Depth from Surface Description <br /> Feet to Feet Describe material,grain size,color,etc City Stockton State­CA_Zip 95209 <br /> 0 10 brown, SILT Wefllocation <br /> 10 20 brown, SILTY SAND,fine grained sand Address North of Instersection of PhelDs and Spring Streets <br /> 20 45 brown, CLAY City Stockton County San Joaquin <br /> 45 50 brown, CLAYEY SAND,fine grained sand Latitude N Longitude -----JN <br /> 50 55 brown, CLAY Dec. Min. Sec. Dep. Min. Sec. <br /> 55 65 j brown, SILTY SAND,fine grained sand Datum Dec.Lat. Dec.Long. <br /> APN Book Page Parcel <br /> Township Range Section <br /> Location Sketch Activit <br /> Sketch must be drawn by hand after form Isprinted.) Qi New Well <br /> North O Modification/Repair <br /> O Deepen <br /> O Other <br /> O Destroy <br /> Describe procedures and materials <br /> under"GEOLOGIC LOG" <br /> Planned Uses <br /> O Water Supply <br /> [:]Domestic ❑Public <br /> u ❑Irrigation ❑Industrial <br /> Cathodic Protection <br /> O Dewatering <br /> O Heat Exchange <br /> O Injection <br /> (D Monitoring <br /> O Remediation <br /> O Sparging <br /> South O Test Well <br /> Illustrate or describe distance of well from roads,buildings,fences, O vapor Extraction <br /> rivers,etc.and attach a map. Use additional paper if necessary. O Other <br /> Please be accurate and com late. <br /> ' iter Level and Yield of Com plet6d Well <br /> Depth to first water 35 (Feet below surface) <br /> Depth to Static <br /> Water Level (Feet) Date Measured <br /> Total Depth of Boring 65 Feet Estimated Yield* (GPM) Test Type <br /> Total Depth of Completed Well 65 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 Fill Description <br /> Feet to Feet Inches Inches Inches Inches Feet to Feet <br /> 0 155 8 Blank I PVC Sch.40 0.154 2 1 50 Cement Portland Cement <br /> 55 65 8 Screen PVC Sch.40 0.154 2 Milled Slots 0.020 50 53 Bentonite Bentonite Pellets <br /> 53 65 Filter Pack #3 Sand <br /> Attachments Certification Statement <br /> ❑ Geologic Log I,the undersigned,certify that this report is complete and accurate to the best of my knowledge and belief <br /> ❑Well Construction Diagram Name Woodward Drilling <br /> ❑ Geophysical Log(s) 550 River Roadm orCorporation <br /> Rio Vista CA 94571 <br /> ❑ Soil/Water Chemical Analyses Address GA city State zip <br /> ❑ Other Signed Lf&&&deQ 01/28/2015 710079 <br /> Attach additional information if it exists. C-57 Licensed We er ell Contractor Date Signed C-57 License Number <br /> DWR 188 REV.1/2006 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />