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*The free Adobe Reader may be used to view and completlaorm. However,software must be purchased to complete,sa0d <br /> reuse a saved form. <br /> File Original with DWR State of Califomie DWR'tlse`Qr -Do'Not Fill t <br /> Pa3 of 3 Well Completion Report <br /> RefePage _ r to Instruction Pamphlet _ State Well Number/Site Number <br /> Owner's Well Number MW-12 Noe0219699 <br /> wl <br /> Date Work Began 04/26/2014 Date Work Ended 4/28/2014 I Latitude de II Longitude <br /> Local Permit Agency San Joaquin County Environmental Health D Dartment <br /> Permit Number SR#0069442 Permit Date 4/16/14 APN/TRS/Other <br /> Kill <br /> Orientation C Veaical O Horizuntal OAnglo Specify Name City of StocKton <br /> Drilling Method Sonic Drilling Fluid <br /> Mailing Address 425 EI Dorado Street <br /> - , 2 <br /> icy,;.! <br /> Cit Brockton <br /> -a State-GLA—Zip J520 <br /> 92 95 Lean clay, dark greenish gray, dry,fine sand, clay, <br /> — medium plasticity, hard Address ?624 S Stockton Street <br /> —_—_— City Stockton County San Joaquin <br /> Latitude N Longitude _y. <br /> D=a. Min. Sec. Dea MieSec. <br /> Datum Decimal Lat. Decimal Long. <br /> APN Book Page Parcel <br /> T ownship Range. Section <br /> Q New Well <br /> Nom' Q Modification/Repair <br /> O Deepen <br /> O Other- <br /> 0 Destroy <br /> Describe procedures and materials <br /> under XzEOLOGIC LOG` <br /> r <br /> O Water Supply <br /> --- ---- --- ElDemestic ❑Fublic <br /> W E7lrrigation ❑industrial <br /> --—— -- —- ——-- - O Cathodic f roiectim i <br /> -- — - ---—i O Dewatering <br /> O Heat Exchange <br /> O Injection <br /> e Monitoring <br /> O Remediation <br /> O Sparging <br /> yG�t� ^O Test Well <br /> Illus-sate or describe dictanc,of w!1(rom:oads,wildmgs,rences, O Vapor Extraction <br /> rivers, entl attach a map.Use additional paper t necessary. O Other <br /> Please be accurate ane com leh. <br /> ---- --- Depth 10 first water 41 (Feet below surface) <br /> Deptn to Static <br /> Vlater Level 75 Date Neasured— <br /> j Tctal Depth of 9erir:3 7_5_ Feet rstimate 1 Y*.elc' --_(CP[4) Tsst T;rpe <br /> ! Test Length: — (Hours) -offal Drawdown ;Feet) <br /> Total Depth of Completed Well 86 Feet *e,l�i Pot be-e resentative of a well's laig term ieid. <br /> FRMY=T7 VAT THMAIMOW"Off—M <br /> Depth from Borehole Wall Outside Screen Slot Sb a Depth from <br /> Surface Diameter Type Material Thickness Diameter Type if Any Surface Flit Description <br /> Feet to Fee: Inches` 'Inches) Inches Inche:' Feet ii Feet <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 National EWP. Inc-Chris Tatum <br /> Person,Firm or Corporation <br /> E7 Geophysical Lcg(s) V 1961 Meeker Avenue Ricilmono. CA 94804 <br /> 0ii"VIjutor Cllent kai f,nolvi65 Aodress��_ ,, lata /1P1/3 Other Sig,-:Ed_ _--7/�- __ -- l z'� --- 0,536.16 <br /> Lttach7a—d'oiticnai i:Ifcrmatlon,if it exists. C-5?Licen:7d Wafer Well Con'racio. Dake SI ned C-57 License Numoel <br /> GWR 1158 REV.1/2006 IF ADDITIONAL SPACE IS NEEDED.USE NEXT CONSECUTIVE!.Y NUMBERED FORM <br />