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'The free Adobe Reader may be used to view and complete Is form. However,software must be purchased to complate, e,and reuse a saved form. <br /> File Original with DWR State of California 3W DWR Use Onl —Do Nat Fill In <br /> Pae 1 of 1 Well Completion Report <br /> 9 Refer <br /> O.toInstructionPamphlet �umber/Sile Number <br /> Owner's Well Number MW-18-80/MW-18-120 No. e0149731 N <br /> D to Work Began 10/03/2011 Date Work Ended 10/8/2011 W <br /> Latitude Lon nude <br /> I Permit Agency San Joaquin County mit Number 0063508 Permit Date 9/20/11 APN/TRS/Other <br /> Geolo is Log Well Owner <br /> Orientation OVertical 0Horizontal OAngle Specify <br /> Name Major Singh <br /> Drilling Method Sonic Drilling Fluid <br /> Depth from Surface Description <br /> Mailing Address 440 W Charter Way <br /> Fast to Feet Describe material,grain size,color,etc City Stockton StateCA ip 95206 <br /> WELL DESTRUCTION:Overdrill 6"well from Well Location <br /> 0 to 120',backfill with cement,removed upper Address 440 W Charter Way <br /> 8', backfill with native fill City Stockton County San Joaquin <br /> Latitude N Longitude yy <br /> Deq. Min. Be. Deq. Min. Sec. <br /> Datum Decimal Lat. Decimal Long. <br /> APN Book 165 Page 03 Parcel 018 <br /> Townshi <br /> Rance Section <br /> Location Sketch Activit _ <br /> Sketch must W draveri by nand after forms printed.I ONew We II <br /> North O Modification/Repair <br /> O Deepen <br /> O Other <br /> - <br /> (D Destroy <br /> D...I I.promdure and metenela <br /> under'GEOLOGIC LOG' <br /> Planned Uses <br /> O Water Supply <br /> _ ❑Domestic ❑Public <br /> u, ❑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 /> Ilwsnne or describe dinance of well ream roads.dumlres.lanes, OVapor Extraction <br /> >Ne r.,ria.end ansa.map.us mdnlonal paper n necsearv. O Other <br /> Nese eeaaurn..na com Ie4. <br /> Water Level and Yield of Completed Well <br /> Depth to first water (Feet below surface) <br /> Depth to Static <br /> Water Level (Feet) Date Measured <br /> Total Depth of Boring Feet Estimated Yield" (GPM) Test Type <br /> Test Length (Hours) Total Drawdown (Feet) <br /> Total Depth of Completed Well Feet *May not be representative of a well's Iona term viell . <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 /> Feel to Feet Inches Inches Inches Inches Feet to Feel <br /> 0 $ Fill <br /> 8 120 Cement <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 WDC Exploration&Wells <br /> Person,Firm or Corporation <br /> 13 Geophysical Log(s) 9580 Coun d 93B mora CA 95698 <br /> ❑ Soil/Water Chemical Analysesddress city sate Zi <br /> O Other Site Map Signe 4/25/12 283326 p <br /> 7AIach additional information alt exists. -s7 Licensed water a Comractor Date Signed C-57 License Number <br /> DWR 186 REV.112006 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />