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i. "The free Adobe Reader may be used to view and comply is form. However,software must be purchased to complete,snd reuse a saved form. <br /> File Original with DWR State of Califomia DWR Use Only-Do Nbt'Fill In <br /> Well Completion Report <br /> Page 3 of 3 Refer to+nsirucrionPamp-1el State Well Number/Site Number <br /> Owner's Well Number MW-3 No• e0145432 i N W <br /> Date Work Began 01/1212012 Date Work Ended 1!1212012 Latitude Longitude <br /> Local Permit Agency San O@aIJJn County APNrrRsroI <br /> Permit Number Permit Date 12/27/11 !? <br /> tber <br /> Geolo-is„Lo <br /> {. Well owner <br /> orientation OVertical O Horizontal OAngle Specify Mame Sukhwlnder Singh <br /> Drilling Method Hollow Stem Au er Drilling Fluid Bentonite mud IN-tailing Address 8807 Bergamo Circle <br /> Depth from Surface Description Stockton State CA �i 95212 <br /> t Feet to Feet Describe.material, rain size,color,etc Crit <br /> 45 10 lPressure Grout Il , Well Location <br /> P Jdress 244West-HardinaWgy <br /> City Stockton County San Joaquin <br /> Latitude i' N Longitude <br /> Deo. Min, Sec Dev. Min. Sec <br /> C atum Decimal Lat. Decimal Long, <br /> A'N Book J37 i Page 080 Parcel 14 <br /> _ 7)wnshi ._ 1 -Ran e. - Sed an — `I <br /> Location Sketch Actm <br /> 'Sketch must 48 drawn 6,hand after form is rimed. O New Well <br /> f North Modification/Repair <br /> Q Deepen <br /> O Other <br /> Q Destroy <br /> -.t t Dmoribe procedures end materle4 <br /> t C, under'GEOLOGIC LOG' <br /> Planned Uses <br /> Q Water Supply <br /> ❑Domestic ❑Public <br /> it J ❑Irrigation ❑Industrial <br /> O Cathodic Protection <br /> 0 Dewatering <br /> I' 0 Heat Exchange <br /> I � I` <br /> 0 Injection <br /> l <br /> c; O Monitoring <br /> Remediation <br /> O Sparging <br /> lh South O Test Well <br /> Illusra[e or describe rhslance of well from roads,buddinpa,fences, O Vapor Extraction <br /> rive+[.e[c and attach a map,Use'addiGonel paper i1 nec2e.rc O Other <br /> Pku+e be eecurafe'entl eom lata. <br /> :ter Level and Yield of Completed Well <br /> Depth to first water (Feet below surface) <br /> Depth to Static <br /> ... _:..o.��..�.�._.. �..-„� ,�q„� +-•,+°-••,r W:Iter Levei - _ (Feet) Date Peaued” <br /> Total �-._ �-.... <br /> �. <br /> Depth of Boring 45 Feet Es,imated Yield” (GPM) Test Type <br /> Teat Length 11 M (Houts) Total Drawdown (Feet) <br /> Total Depth of Completed Well 45 Feet •M,t not be'te resentative of a welt's long term yield. <br /> Casin s._ ?'r Annular Material <br /> Depth from Borehole Wall Outside Scrsen Slot Size Depth from <br /> Surface Diameter Type Material Thickness Diameter Ty�:,e if Any Surface Fill Description <br /> Feet to Feet Inches Inches Inches Inches Feet to Feet <br /> Iry <br /> If <br /> r <br /> A'ttachmerrts 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 /> 0 Well Construction Diagram Name All Well Abandonment _ <br /> Person,Firm Corporation <br /> ❑Geophysical Log(s) 9245 Seatt Driveor Suite A SacramentoCA 95826 <br /> SS rye ater Chemical Analyses Address City stare zip <br /> Signed 2/6/2012 848359 <br /> additionr i <br /> arlfv <br /> orinaor!n it exists. C-57 Licensed Water Well Contc:cter <br /> + Attach ;� Date Signed C-57 License Number <br /> DWR 188 REV.12006 IF ADDITIONAL SPACE IS NEEDED,USE N7 T CONSECUTIVELY NUMBERED FORM <br /> ii <br />