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'The free Adobe Reader may be used to view and complete tt is� However,software must be purchased to complete,save,am se a saved form. <br /> File Original with DWR State of California WR Use Onl -Do Not Fill In <br /> Well Completion Report <br /> Page 1 of 1 Refer to Instruction Pamphlet ==State Number/Skeber/SkeNum <br /> Owners Well Number MW-13 No. e0264629 <br /> Date Work Began 04/09/2015 Date V1'orf E Ced 4/912015— Latitude Lon iwde <br /> Local Permit Agency Ga IT JDeg uin County Env!TOO l!IQ)tu1 Health DeDartment <br /> Permit Date 4/3';5 APN/TRS/Other <br /> Permit Number <br /> Geologic Log Well Owner <br /> Orientation OVertical O Horizontal (i A,1g o Specity__ Name Herman&Helen's Marina(DFRD 2029) <br /> Drilling Method Hollow Stem Au er 7dll ng 9uid Bentonite mud Mailing Address 15135 West Eight Mlle RD <br /> Depth from Surface Description Stockton State CA 7i 95215 <br /> Feet to Feet Describe material, :ain sin color,etc Cit, <br /> 13 0 2"Overdrill Well Location <br /> Address 15135 Eight Mile RD <br /> ._ City Stockton County San Joaquin <br /> Latitude N Longitude ___yy <br /> ---- Deg. Min. Sec. Dia. Min. Sec. <br /> -- Datum Dec.Let. Dec.Long. <br /> ---- APN Book Page Parcel <br /> -- <br /> Township Rance Section <br /> '— Location Sketch Activity <br /> — Sketch must be drawn b hand after form is printed) O New Well <br /> -- North O Modification/Repair <br /> O Deepen <br /> -- O Other <br /> --- O Destroy <br /> Celesta P.rAmras and ni.Iusa. <br /> .-- indx'GEOLOGIO LOG' <br /> -- Planned Uses <br /> -- ' O Water Supply <br /> --.. ❑Domestic ❑Public <br /> w ❑lnigation ❑Industrial <br /> 3 <br /> ._--, O Cathodic Protection <br /> O Dewatering <br /> O Heat Exchange <br /> -- O Injection <br /> -- O Monitoring <br /> --- O Remediation <br /> .--- Sparging <br /> — South O Test Well <br /> Vapor Extraction <br /> --" nvem etc de mm�.mao.Useeadin anonal Pepe,ofnnnane,. OOther <br /> —" Pk sebe.c rakmdcom kt.. ��� <br /> -- Nater 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 13 __ Feet Estimated Yield• (GPM) Test Type <br /> Test Length (Hours) Total Drawdown_(Feet) <br /> Total Depth of Completed Well 13 Feet •Ma not be re resentative of a well's Ion term field. <br /> Casi'g; Annular Material <br /> Depth from Borehole Te Materal well Outside Screen Slot Size Depth from <br /> Fill Description <br /> Surface Diameter Thickness Diameter Type If Any Surface <br /> Type <br /> Feet to Feet Inches .-- Inches Inches inches Feet to Feet <br /> Attachments Certification Statement <br /> � I, hE,.lndersigned,ca:rtiTy that this report is complete and accurate to the best of my knowledge and belief <br /> ❑ Geologic Log Na E All Well Abandonment Inc <br /> ❑Well Construction Diagram Person,Firm or corporation <br /> ❑ Geophysical Log(s) _36,1 Fitzgerald F:D suite B anch0 Cordova CA 95742 <br /> A City state zip <br /> 1:1SoiUWater Chemical Analyses Si In= 4/27/2015 848359 <br /> D Other Site Mao sT U. el ornractor Date Signed C-57 License Number <br /> Attach addifimsl imnrmation M it e>osls. �, <br /> DWR 188 REV.wixe IF 1DI1''IONAL ACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />