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'The free Adobe Reader may be used to view and complete this form. However,software must be purchased to complete.save..and reuse a saved form. <br /> File Original with DWR State of California DWR Use Only—Do Not Fill in <br /> Page of Well Completion Report Phlet <br /> Siete Well Num <br /> Owners Well Number V-26 No. e0101366 I I I Number <br /> Date Work Began 71/05/2009 Date Work Ended 11/5!2009 Latiwdertle <br /> Local Permit Agency San Joaguin County Environmental Health Department <br /> Permit Number SR-58521 Permit Date 10/12/09 APN/rRa/other <br /> Geologic Log Well Owner <br /> Orientation O Vertical O Horizontal OAngle Specify Name City Of Stockton. Public Works <br /> Drilling Method Pressure Grout Drilling Fluid Portland <br /> Mailing Address 425 N. EI Dorado Street <br /> Depth from Surface Description <br /> Feet to Feet Describe material,grain size color,etc flyStockton State_CA__Zip 95202 <br /> 0 120 Filled with grout usinq trem I Well Location <br /> water into drum.Top off wi dress 2000 Block American Street <br /> 25 psi for 5 minutes to abandon. City Stockton County San Joaquin <br /> Latitude N Longitude __�N <br /> No drilling done. L1 Dea. Min. Sec. Cel. Min. Sec. <br /> I tum Decimal Lat. Decimal Long. <br /> r APN Book Page Parcel <br /> Townshi —Range Section <br /> Location Sketch Activity <br /> Sketch must De drawn by hand aflerfoan is prinpeil O New Well <br /> North O Modification/Repair T-�S1 <br /> O Deepen .T' <br /> O Other <br /> e0 Destroy <br /> neawibe procetlures mtl mernink <br /> maker'GEOLOGIC LOG' <br /> Planned Uses <br /> O Water Supply <br /> []Domestic ❑Public <br /> Ir w []Irrigation ❑Industrial <br /> O Cathodic Protection <br /> O Dewatering <br /> O Heat Exchange <br /> O Injection <br /> 0e Monitoring 1 <br /> O Remediation <br /> O Sparging <br /> South O Test Well <br /> ik,ebme in deacm,as,aeea arwell from readi buildings.fences. O Vapor Extraction <br /> vem.and ahem a map.use addnenai yap.,if necessary O Other <br /> ,...ebeaeeura,eaedaom lete. <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 /> Total Depth of Completed Well 120 Feet Test Length (Hours) Total Drawdown (Feet) <br /> *May not be representative of a well's long term yield. <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 /> Feet to Fast Inches Inches Inches Inches Feet to Feet <br /> 120 110 1 1 1PVC 1 12 .010 0 120 Portland 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 Cascade Drilling L.P. <br /> Person,Firm or Corporation <br /> ❑Geophysical LO s 3632 Cie <br /> Rancho Cordova CA 95742 <br /> ❑SoillWater Chemical Analyses dd as city stale TP <br /> ❑� Other Site Mao Signed lT�KT 11/16/2009 938110 <br /> Anadt additional intormetion If it ebsls, Cbl Licari ed Water well Coinrador Date Signed C-57 License Number <br /> DWR 188 REV.112006 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />