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ORIGINAL STATE OF CALIFOIINIA OWR USE ONLY — 00 NOT FILL IN <br /> File with DWR WELL COMPLETION REPORT <br /> !'age <br /> Refer to ln.struclion Prrnr)�ldef STATE WELL NO.lS7ATION N0. <br /> of? W_pt No. e0300760t ❑F7L I ❑ <br /> Owner's Well No. •��?ttG LATITUDE LONGITUDE <br /> Date Work Began , Ended <br /> Local Permit Agency SA Joaquin County Environme tal Health <br /> APNlTRSlOTHEn <br /> Permit No. 2902 Pern7it Date October 28,2015 <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION (—✓) x VERTICAL —HORIZONTAL —ANGLE —(SPECIFY) Name Swaran Chouban - <br /> DRILLING Sonic Mailing Address 1632 Paola Place <br /> DEPTH FROM METHOD FLUID Manteca CA 95337 <br /> SURFACE DESCRIPTION STATE ZIP <br /> 17escribe material, grain size, calor, etc. CITY <br /> Fl. to FI. WELL LOCATION <br /> Address 701 E.Charter Way <br /> City Stockton <br /> County San Joaquin <br /> APN Book Page Parcel 147-343-11 <br /> Township 1N Range 6E Section 2 <br /> I I Latitude 37.0015640 l 62 NORTH Lgllgltnde 121.00 16.60 33.00 WEST <br /> DEG. MIN. SEC, DEG. MIN. SEC.. <br /> LOCATION SKETCH ACTIVITY {!) <br /> NORTH NEW WELL <br /> MODIFICATIONIREPAIR <br /> See Attached Map _ Deepen <br /> — Other(Specify) <br /> I I X DESTROY(Describe <br /> Procedures and Maferra)s <br /> I I Under"GEOLOGIC LOG") <br /> PLANNED USES (z�) <br /> i 1 I WATER SUPPLY <br /> Domestic Public <br /> I I F Inigalion Industrial <br /> I I IIJ MONITCRING x <br /> I I <br /> TEST WELL <br /> CATHODIC PROTECTION _ <br /> HEAT EXCHANGE <br /> i <br /> DIRECT PUSH <br /> INJECTION_ <br /> l r VAPOR EXTRACTION <br /> i SPARGiNG — <br /> I I <br /> SOUTH REMEMATION <br /> fRamyne or Describe Dislaofv of{Voll Inuit RrNrds.Buildinws, <br /> Fences,R(een,Mr.and erffticie a map. Ike reddittrnlydIdler if OTHER(SPECIFY) <br /> I neressnry.PLEASE BE ACCURATE&COMPLETE. <br /> WATER LEVEL br YIELD OF,COMPLETED WELL <br /> I I <br /> r I <br /> DEPTH TO FIRST WATER ala (Ft.) BELOW SURFACE <br /> DEPTH OF STATIC <br /> ' WATER LEVEL (Ft.)&DATE MEASURED <br /> JJ ESTIMATED YIELD ' nla (GPM)& TEST TVP <br /> TOTAL DEPTH OF BORING 150 (Feet) TEST LENGTH (Hrs.)TOTAL DRAWDOWN_ _ <br /> TOTAL DEPTH OF COMPLETED WELL160 (Feet) "May not he representative of a well's long-term yield. <br /> a <br /> DEPTHE-HOLE TYPE(�3 CASIN S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE HO <br /> tFROM SURFACE TYPE <br /> DIA. T MATERIAL 1 INTE A GAUGE SLOT SIZE CE- BEN- <br /> pnches) '' 1 i GRADE DIAME OR WALL IF ANY MENT TONITE FILL FILTER PACK <br /> Ft. to Ft. (Inch al THICKNESS (Inches) Ft. to Ft. (TYPElSIZE) <br /> i l0 0.0 l X <br /> I I <br /> I <br /> 1 <br /> I <br /> t ATTACHMENTS (zL) 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 /> Wed Construction Diagram NAME BC2 Environmental <br /> (PERSON, FIRM, �van <br /> OR TI (TYPED OR PRIHT I <br /> _ Geophysical Log(s) <br /> 1150 W.Trentonu Orange CA 92867 <br /> SoIVWater Chemical Analyses <br /> X Other Site Map ADDRESS CITY STATE ZIP <br /> cz�ksll(o <br /> i A7TACH ADDITIONAL (NFORMATION, IF IT EXISTS. 9rgned <br /> WEU.GRILLE IVE DATE SIGNVD C-57 LICENSE NUMBER <br /> D%VR 189 REV. ss-D. IF ADDITIONAL SPACE IS NEEDED, USE NEXT CONSECUTIVELY NUMBERED.FORM <br />