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I; <br /> I <br /> 'The free Adobe Reader may be used to view and comp_ Is form, However,software must bu purchased to complete,sand reuse a saved form. <br /> File Original with DWR w State of Californl;ii DWR Use Only--Do Not Fill In <br /> Page 2 of 3 Well Completion Report <br /> Refer to restrucrion Pamprlret Stale Wei!NumberlSite Number <br /> Owner's Well Number MW-2 NO-e0145430 N w <br /> Date Work Began 01/12/2012 Date Work Ended 111212012 Latitude Longitude <br /> Local Permit Agency di <br /> Permit Number 0064Q76 Permit Date 12/27/11APN/TRS/other <br /> I <br /> Geologic Lo I'I <br /> Well Owder <br /> Orientation OVertical 0HorizontaI OAngle Specify P'ame SukhwinderSin h <br /> Drilling Method Hollow Stem Auger Drilling Fluid Benton}te mud 1F <br /> Dolph frOm,$llrface Description M1ilail#ng Address 8807 Ber amo Circle <br /> j Feet '16- -Feet Describe material,grain size,color,etc Cit Stockton # State C�Zi 95212 <br /> t 45 10 Pressure Grout 1; Well Location <br /> Address 244 West Hardinq Way <br /> City Stockton County San Joa7sec. <br /> Lrttitude N Longitude Dep. Min. Sec. Deq- <br /> ' C.tum Decimal Let, Decimal Long. <br /> A1 <br /> 3 N Book 137 Page 0$0 Parcel 14 <br /> IF "- <br /> ~. ._�. _. ._. T,nvnshi _Ran ems-' 'Seaton <br /> Locatlon Sketch Adtivl <br /> _(Sketch must be.dra"b hand after form is,nnletl. 0 New Well <br /> worth 0 Modification/Repair � <br /> I I 0 Deepen <br /> O ether <br /> { , 0 Destroy <br /> Describe'GHpOriOeGduIC enma[mialc under <br /> LOG' <br /> Planned Uses <br /> 0 Water Supply <br /> []Domestic ❑Public <br /> � ❑Irrigation ❑Industrial <br /> } 0 Cathodic Protection <br /> ` 0 Dewatering <br /> 0 Heat Exchange <br /> r O Injection <br /> LC 0 Monitoring <br /> 0 Remediation <br /> 0 Sparging <br /> South 0 Test Well <br /> Iliusc its describe dis?nee of"n from roads,hWid�ngs,fence., 0 Vapor Extraction <br /> dvan etcend attach a map,u.r adahwrii paper i1 necessary. O Other <br /> Pt.-:--be accurate and cornlett. ;h <br /> .-,ter Level and Yield of Completed Well <br /> 3 <br /> Death to first water (Feet below surface) <br /> Death to Static <br /> _ L <br /> _---—(Feet) <br /> , ,13aie lUEeasuied� -���=3' <br /> -Tota!Depth'of Boring. � � 45 - _ ,�-Feer-- - - Estimated Yield' �� <br /> (GPM) Test Type <br /> Total Depth of Completed Wen 45 Feet Tesl Length I} (Hours) Total Drawdown (Feat) <br /> 'Ma not be re resentaiive of a well's Ion term yield. <br /> t <br /> Casings it p Annular Material <br /> Depth from Borehole wall Outside Scree n Slot Size Depth from <br /> Surface Diameter Type Material Thickness Diameter Typu If Any <br /> Feet Feet Inches Surface Fill Description <br /> to Inches Inches Inches Feet to Feet <br /> { <br /> I� <br /> Il <br /> i <br /> I� <br /> it <br /> Attachments _ Certification Statement <br /> ❑ Geologic Log I,the undersigned,certify that this report is complete andlaccurate to the best of my knowledge and belief <br /> ❑ Well Construction Diagram Name All Well Abandonment <br /> ❑ Geophysical Log(s) Pa son,Firm or Corporation I, <br /> ❑ Soil/Water Chemical Analyses 9245 Bean DrAddress <br /> iv�eA Sacramento CA 95826 <br /> { ❑Other Signed cit zip <br /> City <br /> Attach additional itlftlrmafion if it exssts. C-57 Licensed Water Well Conlrat�-or ' 2/6/2012 848359 <br /> p 1 <br /> QDate Si ned C-57 License Number <br /> t VVR 188 REV IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br /> t <br /> i <br />