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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 1 of 1 Well Completion Report <br /> Refer to Instruction Pamphlet State Well Number/Site Number <br /> Owner's Well Number Stockton 56-01 No. e0338846 N W <br /> Date Work Began 10/03/2016 ��— � <br /> 9 Date Work Ended 3/21/2017 Latitude Lon itude <br /> Local Permit Agency San Joaquin Countv Environmental Health DeDartment I I I I <br /> Permit Number SR0076758 Permit Date 2/9/17 APN/TRS/Other <br /> Geologic Log Well Owner <br /> Orientation O Vertical O Horizontal OAngle Specify Name California Water Service Company <br /> Drilling Method Drilling Fluid <br /> Depth from Surface Mailing Address 1720 North First Street <br /> P Description <br /> Feet to Feet Describe material,grain size,color,etc City San Jose State_CA__Zip 95112 <br /> 5 234 10.3 Sack Mix Well Location <br /> 30 234 Blast Perforated Well Address 1 Glendora Way <br /> City Stockton County San Joaquin <br /> Latitude N Longitude W <br /> Dea. Min. Sec. Dec. Min. Sec <br /> Datum Dec. Lat. Dec. Long. <br /> APN Book 081 Page 346 Parcel 013 <br /> Township Ranga Section <br /> Location Sketch Activit <br /> Sketch must be drawn by hand after form isprinted.) O New Well <br /> North <br /> O Modification/Repair <br /> O Deepen <br /> O Other <br /> O Destroy <br /> Oescribe procedures and materials <br /> under"GEOLOGIC LOG' <br /> Planned Uses <br /> O Water Supply <br /> r ❑Domestic [L—]Public <br /> El Irrigation El Industrial <br /> w <br /> O Cathodic Protection <br /> O Dewatering <br /> O Heat Exchange <br /> O Injection <br /> O Monitoring <br /> O Remediation <br /> O Sparging <br /> South O Test Well <br /> ulusbats er describe distance erwell from roads.buildings,fences. O Vapor Extraction <br /> rivers,etc.and attach a map. Use additional paper if necessary. O (Other <br /> 1PI.a..b...e.r.teeind—na let.. <br /> Water Level and Yield of Com leted Well <br /> Depth to first water (Feet below surface) <br /> Depth to Static <br /> Water Level (Feet) Date Measured <br /> Total Depth of Boring 234 Feet Estimated Yield' (GPM) Test Type <br /> Total Depth of Completed Well 234 Feet Test Length (Hours) Total Drawdown (Feet) <br /> `Ma not be representative of a well's long term yield. <br /> Casings Annular Material <br /> Depth from Borehole WallOutside Screen Slot Size Depth from <br /> Surface Diameter Type Material Thickness Diameter Type if Any Surface Fill Description <br /> Feet to Feet nches Inches Inches Inches Feet to Feet <br /> 5 234 Fill Pipe Steel 112 5 234 Cement 18 yds. 10 SaCkMix <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 Salinas Pump Company <br /> Person,Firm or Corporation <br /> ❑ Geophysical Log(s) 21935 Rosehart Wav 1 Salinas CA 93908 <br /> ElSoil/Water Chemical Analyses Address ' Cay State zip <br /> ❑ Other Signed 1 " t'-? ' 515945 <br /> Attach additional information if it exists. C-57 Licensed water Well Contractor Date Signed C-57 License Number <br /> DWR 188 REV.1/2006 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />