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ke free Adobe Reader may be used to view and complett orm. However,software must be purchased to complete,sareuse a saved form. <br /> File Original with DWR State of California DWR Use Only—Do Not Fill In <br /> Page 1 of 1 Well Completion Report <br /> Refer to Instruction Pamphlet State Well Number/Site Number <br /> Owner's Well Number MW-16 No. e0252474 <br /> Date Work Began 01/26/2015Date Work Ended 1/26/2015 N W <br /> Latitude Longitude <br /> Local Permit Agency San Joaquin County Environmental Health De artm nt <br /> Permit Number SR#71308 Permit Date 1/7/15 APN/TRS/Other <br /> Geologic Log Well Owner <br /> Orientation O Vertical O Horizontal OAngle Specify Name Peter Bui and Kimberly Hoanq <br /> Drilling Method Hollow Stem Auger Drilling Fluid <br /> Depth from Surface Mailing Address 4004 Maddie Circle <br /> P Description <br /> Feet to Feet Describe material,grain size,color,etc City Stockton State CA 7ip 95209 <br /> 0 10 brown, SILT Well Location <br /> 10 20 brown, SILTY SAND,fine grained sand Address East of Instersection of PhelDs and SDrincl Streets <br /> 20 45 brown, CLAY City Stockton County San Joaquin <br /> 45 50 brown, CLAYEY SAND,fine grained sand Latitude <br /> N Longitude <br /> Deo. Min. Sec. Dec. Min. Sec. <br /> Datum Dec.Lat. Dec.Long. <br /> APN Book Page Parcel <br /> Township Ran2e Section <br /> Location Sketch Activit <br /> Sketch must be drawn by hand after form is rinted. O New Well <br /> North O Modification/Repair <br /> O Deepen <br /> O Other <br /> O Destroy <br /> Describe procedures and materials <br /> unoer"GEOLOGIC LOG" <br /> Planned Uses <br /> O Water Supply <br /> ❑Domestic ❑Public <br /> to LU ❑Irrigation ❑Industrial <br /> O Cathodic Protection <br /> O Dewatering <br /> O Heat Exchange <br /> O Injection <br /> O 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 lete. <br /> Water Level and Yield of Com1pi6ted 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 Annular Material <br /> Depth from Borehole Type MateriaWall Outside Screen Slot Size Depth from <br /> Material Surface Diameter 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 12 1 1 25 Cement Portland Cement <br /> 30 150 18 Screen PVC Sch.40 0.154 12 Milled Slots 10.020 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 Drillinq <br /> Person,Firm or Corporation <br /> ❑ Geophysical Log(s) 550 River oad Rio Vista CA 94571 <br /> ❑ Soil/Water Chemical Analyses 11 Address State zip <br /> ❑ Other Signed1/28/2015 710079 <br /> Attach additional information if it exists. C-57 Licensed Water ell Contractor Date SI ned C-57 License Number <br /> DWR 188 REV.1/2006 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />