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State of California <br /> Well Completion Report <br /> Form DWR 188 Auto-Completed 6/11/2018 <br /> WCR2018-003000 <br /> Owner's Well Number MW-80B Date Work Began 04/05/2018 Date Work Ended 04/05/2018 <br /> Local Permit Agency San Joaquin County Environmental Health Department <br /> Secondary Permit Agency Permit Number WP0037934 Permit Date 02/07/2018 <br /> Well Owner (must remain confidential pursuant to Water Code 13752) Planned Use and Activity <br /> Name XXXXXXXXXXXXXXXXXXXX Activity Other-REPAIR TOP 3' <br /> Mailing Address XXXXXXXXXXXXXXXXXXXX <br /> Planned Use Monitoring <br /> XXXXXXXXXXXXXXXXXXXX <br /> City XXXXXXXXXXXXXXXXXXXX State XX Zip XXXXX <br /> Well Location <br /> Address 22888 KASSON RD APN 239-050-23 <br /> City TRACY Zip 95304 County San Joaquin Township 02S <br /> Latitude N Longitude W Range 06 E <br /> Section 19 <br /> Deg. Min. Sec. Deg. Min. Sec. Baseline Meridian Mount Diablo <br /> Dec.Lat. 37.7517456 Dec.Long. -121.3469739 Ground Surface Elevation <br /> Vertical Datum Horizontal Datum WGS84 Elevation Accuracy <br /> Location Accuracy Location Determination Method Elevation Determination Method <br /> Borehole Information Water Level and Yield of Completed Well <br /> Orientation Vertical Specify Depth to first water (Feet below surface) <br /> Drilling Method Drilling Fluid Depth to Static <br /> Water Level (Feet) Date Measured <br /> Total Depth of Boring Feet Estimated Yield' (GPM) Test Type <br /> Test Length (Hours) Total Drawdown (feet) <br /> Total Depth of Completed Well 0 Feet May not be representative of a well's long term yield. <br /> Casings <br /> Wall Outside Slot Size <br /> Casing Depth from Surface Screen <br /> # Feet to Feet Casing Type Material Casings Specificatons Thickness Diameter Type if any Description <br /> (inches) (inches) (inches) <br /> Annular Material <br /> Depth from <br /> Surface Fill Fill Type Details Filter Pack Size Description <br /> Feet to Feet <br /> Other Observations: <br /> Form DWR 188 rev. 12/19/2017 Page 1 of 2 <br />