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*Thefree Adobe Reader may be used to view and completi0form. However,software must be purchased to complete,sa reuse a saved form. <br /> He Original with DWR State of California DWR Use Only Do Not Fill In <br /> Page 1 of 1 Well Compl e <br /> Refer to insrruc _h! State Well Number/Site Number <br /> Owner's Well Number MW-14 No. e025 7 N W <br /> Date Work Began 01/22/2015 Date Work Ended 1/22/2015 44 19 �? <br /> Latitude Longitude <br /> Local Permit Agency San Joaquin County Environmental Health D Dartment <br /> Permit Number SR#71308 Permit Date 1/7/15 41 APN/TRS/Other <br /> Geologic Lo c"- Well Owner <br /> Orientation O Vertical O Horizontal OAngle Specify a er Bui and KlmberlV Hoang <br /> Drilling Method Hollow Stem Auger Drilling Fluid <br /> Mailing Address 4004 Maddie Circle <br /> Depth from Surface Description <br /> Feet to Feet Describe material,grain size,color,etc City Stockton State CA _Zip 95209 <br /> 0 10 brown, SILT Well Location <br /> 10 20 brown, SILTY SAND,fine grained sand Address North of Instersection of Phelps and SDrinq Streets <br /> 20 45 brown, CLAY City Stockton County San Joaquin <br /> 45 50 brown, CLAYEY SAND,fine grained sand Latitude N Longitude �N <br /> Dea. Min. sec. Dec. Min. Sec. <br /> 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 formisprinted.) (2) New Well <br /> North 0 Modification/Repair <br /> O Deepen <br /> 0 Other <br /> 0 Destroy <br /> Describe procedures and materials <br /> under"GEOLOGIC LOG" <br /> Planned Uses <br /> 0 Water Supply <br /> []Domestic ❑Public <br /> U-1 ❑Irrigation ❑Industrial <br /> 0 Cathodic Protection <br /> 0 Dewatering <br /> 0 Heat Exchange <br /> 0 Injection <br /> 0 Monitoring <br /> 0 Remediation <br /> 0 Sparging <br /> South 0 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. 0 Other <br /> Please be accurate and complete, <br /> Water Level and Yield of C&nplletedl 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 50 Feet Estimated Yield* (GPM) Test Type <br /> Total Depth of Completed Well 50 Feet Test Length (Hours) Total Drawdown (Feet) <br /> May not be representative of a well's long term yield. <br /> Casings AnnularMaterial <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 30 8 Blank PVC Sch.40 0.154 2 1 125 Cement Portland Cement <br /> 30 50 8 Screen PVC Sch.40 0.154 2 Milled Slots 0.020 25 28 Bentonite Bentonite Pellets <br /> 28 50 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 /> ❑ <br /> Geophysical LO Person,Firm or Corporation <br /> g(S) 550 River Rhoad Rio Vista CA 94571 <br /> ❑ Soil/Water Chemical Analyses ddress ci State zip <br /> ❑ Other Signed 01/28/2015 710079 <br /> Attach additional information if it exists. C-57 Licensed Wate ell Contractor Date Signed C-57 License Number <br /> DWR 188 REV.112006 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />