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nefreeAoobeHeadermay be used to view and Complete form. However,software must be purchased to complete,save,and reuse a saved form. <br /> File Original with DWR State of California <br /> Page 1 of 1 <br /> Well Completion Report DWR Use Onl —DO Not Fill In <br /> Owner's Well Number MW-7 Refer to lnstructron Pamphlet <br /> No. e0149729 umber/Site Number <br /> Date Work Began 10/03/2011 Date Work Ended 10/8/2011 <br /> a 11 N W <br /> I Permit Agency$ao Joaquin County Latitude Longitude <br /> mit Number 0063508Permlt Date 9/20/11 I <br /> AP /TRs/Other <br /> Geologic Lo <br /> Orientation Overtical OHorizontal OAWell Owner <br /> Drilling Melhotl Hollow Stem Auger Drillinging speciry <br /> Fluid Name Major Singh <br /> Depth from Surface Description Mailing Address 440 W Charter Wa <br /> Feet m Feet Describe material, rain size,color,etc I Stockton <br /> WELL DESTRUCTION: Pressure Grout 4"well State C?Zi 95206 <br /> 0 to 45r, backfill wjth cement, removed upper WeII Location <br /> 8r, backfill with native fill Address 440 W Charter Wa <br /> City Stockton <br /> Latitude County San Joaquin <br /> Dec,c. min. sac. N Longitude W <br /> DeD. Min. Sec <br /> Datuni Decimal Let, Decimal Long. <br /> APN Book 165 Page 03 Parcel 018 <br /> Townshi Ran a Section <br /> Location Sketch Activi <br /> Sketch must be drawn b hand after form is n, <br /> North O New Well <br /> O Modification/Repair <br /> O Deepen <br /> O Other. <br /> O' Destroy <br /> Did cdhe wocec res aed materiels <br /> vnder'GEOLOGIC LOG' <br /> Planned Uses <br /> O Water Supply <br /> ❑Domestic ❑Public <br /> a <br /> 3 w ❑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 o,aescdha eismacs of well from reeds,emBmaa,feuccs O vapor Extraction <br /> Pkrs,etcand ehech a map.use addhmnet Paper voacesaan. O Other. <br /> ese Ee¢comb and cpm aa. <br /> ater Level and Yield of Com feted Well <br /> Depth to first water <br /> Depth to Static (Feet below surface) <br /> Water Level (Feet) Date Measured <br /> Total Depth of Boring Feet Estimated Yield' <br /> (GPM) Test Type <br /> Total Depth of Completed Well Feet Test Length (Hours) Total Drawdown_(Feet) <br /> 'Ma i not be re resentative of a well's Ion term ield. <br /> Casin s Annular Material <br /> Depth from Borehole Wall Outside Screen Slot Size Depth from <br /> Surtace Diameter Type Material Thickness Diameter Type if Any Surface Inches to Feet Inches Inches Inches Fill Description <br /> Inches Feet to Feet <br /> 0 6 Fill <br /> 8 45 Cement <br /> Attachments Certification Statement <br /> EJ Geologic Log I,the undersigned,certify that this report is complete and accurate t of to the besmy knowledge and belief <br /> El Well Construction Diagram Name WDC Exploration&Wells <br /> ❑ Geophysical Log(s) Person.Firm or Corporation <br /> ❑ Soil/Water Chemical Analyses 9580 COU d 936 aurora CA 95698 <br /> El Other Site Mao Sign CRY State ZIP <br /> Attach additional information if it exists, -57 Licensed Water ell Contractor <br /> DWR 188 REV.12006 Date Si ned C-57 License Number <br /> IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br /> � � l10�15 <br />