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0ree Adobe Reader may be used to view and comple�form. However,software must be purchased to complete,sa d reuse a saved form. <br /> F e riginal with DWR State of California DWR Use Only Do Not Fill In <br /> st. <br /> Page 1 of 1 Well CO n ; <br /> Refer ioaf State Well Number/Site Number <br /> Owner's Well Number MW-15 No. 478 <br /> �78 <br /> N W <br /> Date Work Began 01/23/2015 Date Work Ended 1/23/2015 3 �Qi� Latitude Lon itude <br /> Local Permit Agency San Joaauin County Environmental Health DeDartm <br /> Permit Number SR#71308 Permit Date 1/7/15 APN/TRS/Other <br /> rig <br /> Geologic Lo q Well Owner <br /> Orientation O Vertical O Horizontal OAngle Specify ame afar Bul and Kimberly Hoang <br /> Drilling Method Hollow Stem Auger Drilling Fluid <br /> Depth from Surface Description Mailing Address 4004 Maddie Circle <br /> Feet to Feet Describe material,grain size,color,etc City Stockton State 95209 <br /> 0 10 brown,SILT Well Location <br /> 10 20 brown,SILTY SAND,fine grained sand Address East of Instersection of Phelps and SDrina Streets <br /> 20 45 brown, CLAY City Stockton County San Joaquin <br /> 45 50 brown, CLAYEY SAND,fine grained sand Latitude N Longitude W <br /> 50 55 brown, CLAY Dea. Min. Sec. Dec. Min. Sec. <br /> 55 65 brown, SILTY SAND,fine grained sand Datum Dec.Lat. Dec.Long. <br /> APN Book Page Parcel <br /> Township Ran a Section <br /> Location Sketch Activit <br /> Sketch must be drawn by hand after form isprinted.) 0 New Well <br /> North 0 Modification/Repair <br /> O Deepen <br /> O Other <br /> 0 Destroy <br /> Describe procedures and materials <br /> under"GEOLOGIC LOG' <br /> Planned Uses <br /> 0 Water Supply <br /> [::]Domestic ❑Public <br /> ILL! [:]Irrigation ❑Industrial <br /> O Cathodic Protection <br /> 0 Dewatering <br /> 0 Heat Exchange <br /> O Injection <br /> 0 Monitoring <br /> O Remediation <br /> 0 Sparging <br /> South 0 Test Well <br /> Illustrate or describe distance of well from roads,buildings,fences, 0 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'Corn 'feted Well <br /> Depth to first water 35 (Feet below surface) <br /> Depth to Static <br /> Water Level (Feet) Date Measured <br /> LTolal, pth of Boring 65 Feet Estimated Yield' (GPM) Test Type <br /> pth of Completed Well 65 Feet Test Length (Hours) Total Drawdown (Feet) <br /> 'Ma 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 55 8 Blank 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 /> ❑ Person,Firm or Corporation <br /> Geophysical Log(s) 550 River <br /> Road Rio Vista CA 94571 <br /> ❑ Soil/Water Chemical Analyses Address ity State zip <br /> ❑ Other Signed 01/28/2015 710079 <br /> Attach additional information if it exists. C-57 Licensed Wa 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 />