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ORIGINALz STATE OF CALIFORNIA DWR USE ONLY — DO NOT FILL IN <br /> Fill withoWR WELL COMPLETION REPORT El I <br /> 2 Refer to liwriiclion Pnullflde, STATE WELL NO.ISTATION NO. <br /> Page—of <br /> MW-8 Noe030076$ ❑ E1 <br /> Owner's Well No. �ryi..,� <br /> 1/19/2016 zoIlko LATITUDE LONGITUDE <br /> Date Work Begun Ended ti <br /> Local Permit Agency San Joaquin County Environ ental Health <br /> h 2902 APNITRSIOTHER <br />[ Permit No. Permit Date October 28,2015 <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION (�) x VERTICAL —HORIZONTAL —ANGLE —(SPECIFY) Name Swaran Chouban <br /> DRILLING METHOD Sonic FLUID Mailing Address 1632 Paola Place CA <br /> DEPTH FROM 95337 <br /> SURFACE DESCRIPTION <br /> F=t. to Ft. Describe rnaterial, grain Size, color, etc. CITY STATE ZIP <br /> WELL LOCATION <br /> I r Address 701 E.Charter Way <br /> 1 City Stockton <br /> 1 County San Joaquin <br /> APN Book Page Parcel 147-343-11 <br /> Township 1N Range 6E Section 2 <br /> 1 i37.00 56.40 62 NORTH gitude 121.001 16.60 1 33.00 WEST <br /> Latitude- <br /> 1 1 Lon <br /> DEG. MIN. SEG. DEG. MIN. SEC. <br /> ' LOCATION SKETCH ACTIVITY (.:L) <br /> I <br /> i I NORTH NEW WELL <br /> See Attached Map MODIFICATIONIREPAIR <br /> Deepen <br /> Other(Specify) <br />' I I <br /> FER <br /> I 1 2 2 2 x DESTROY(Describe <br /> Procedures and Ma l erials <br /> I I Under"GEOLOGIC 400") <br /> I PLANNED USES (.!L) <br /> WATER SUPPLY <br /> - — Damest4c Public <br /> I I - irrigation Industrial <br />{ I I LIJ MONITORING X <br /> I I <br /> TEST WELL— <br /> CATHODIC PROTECTION <br /> I I <br /> HEAT EXCHANGE <br /> DIRECT-PUSH <br /> ' INJECTION <br /> I + VAPOR EXTRACTION <br /> 1 I SPARGING <br /> ` I SOUTH REMEDIATION,,, <br /> lflustrrlle or Descrilx Dfslnnee of IV441(nme Roads.Bnilelings, <br /> 1 1 Fences,Ricesan.,Mc noel xttoch a ntop/.Vie addiilulted)faller if OTHER(SPECIFY( <br /> necessary.PLEASE BE ACCURATE&COMPLETE. <br /> 1 i <br /> WATER LEVEL & YIELD OF COMPLETED WELL <br /> ' + DEPTH TO FIRST WATER ala (M.) BELOW SURFACE <br /> I 1 <br /> t DEPTH OF STATIC <br /> WATER LEVEL (Ft.)&DATE MEASURED <br /> ESTIMATED YIELD ' ala (GPM)&TEST TYPE <br /> TOTAL DEPTH OF BORING 150 (Feet) TEST LENGTH (Hirs.)TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL 150 (Feet) "May-tor he representative of a well's,long-tmn yield. <br /> DEPTH CASING (S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE BORE ITYPE( FROM SURFACE TYPE <br /> HOLE <br /> DIA. n MATERIAL! INTERNAL GAU SLOT SIZE CE- BEN- <br /> (inches) >- GRADE DIAMETER OR WA HF ANY MENT TONITE FILL FILTER PACK <br /> Ft. to Ft. (Inches) TH K (inches) Ft. to Ft. (TYPE/SIZE) <br /> I 0.0 1 X <br /> V NJ A'14 tn F1 <br /> 1 , <br /> r t <br /> ATTACHMENTS CERTIFICATION STATEMENT <br /> I,the undersigned,certify that this report is Complete and accurate to the best of my knowledge and belief. <br /> Geologic Log <br /> i — Well Construction Diagram NAME BC2 Environmental <br /> (PERSON, FIRM, 0 ORPDRA ON) (TYPED OR PRINTED) , <br /> _ Geophysical Log($) <br /> Soil/Water Chemical Analyses 1150 W.Trento Av Orange CA 92867 <br /> X Other Site Map ADDRESS CITY STATE ZIP <br /> S�ed <br /> ATTACH ADDITIONAL INFORMATION, IF IT EXISTS. WELL DRILLEFkAVORIZEk RIPRIEWATIVE GATE VGNED C-57 LICENSE NUMBER <br /> DWR ISS REV. 11-97 IF ADDITIONAL SPACE IS NEEDED, USE NEXT CONSECUTIVELY NUMBERED FORM <br />