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1 <br /> t <br /> 'The free Adobe Reader may be used to view and comple•form. However,software must be purchased to complete,ad reuse a saved form. <br /> File Original with DWR State of California DWR Use Only-Do Not Fill In <br /> Pae of Well Completion Report <br /> Page Refer to Instruction Pamphlet Slate Well Number/Site Number <br /> Owner's Well Number MW-5 No. e0246367 I--��— <br /> Date Work Began 11/24/2014 Date Work Ended 11/24/2014 Latitude Lon ithice <br /> Local Permit Agency San Joaa lin CoUntV Environmental Health <br /> Permit Number 70661 Permit Date 9/30/14 APN/TRS/Other <br /> Geologic Log Well Owner <br /> Orientation O Vertical O Horizontal OAngle Specify Name CA Army National Guard <br /> Drilling Method Auger Drilling Fluid <br /> Depth from Surface Description ' Mailing Address 10260 Mather Blvd. <br /> Feet to Feet Describe material,grain size,color,etc City Mather State CA_Zi 95655 <br /> Overddll to abandon 4"well to 50'and grout to Well Location <br /> surface Address 2000 Stimson Road <br /> City Stockton County San Joaquin <br /> Latitude N Longitude <br /> Dec. Min. Sec. Dec. Min. Sec. <br /> Datum Dec. Lat. Dec.Long. <br /> APN Book Page Parcel <br /> Township —Range Section <br /> Location Sketch Activit <br /> Sketch must bed..o hand aftarham is rimae. ONew Well <br /> North <br /> O Modification/Repair <br /> -' O Deepen <br /> O Other <br /> G) Destroy <br /> Darn%.pmC MM-,ml. <br /> uMer'GEOLOGIL LOG' <br /> Planned Uses,' <br /> O Water Supply <br /> ❑Domestic [I Public <br /> 3 A El Irrigation ❑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 /> ni"—teoldeaeesad®t"Iaar.,aflf—m,.tame.,reeea, O Vapor Extraction <br /> a s.ecaM aeach a map.Useaednonal weCrRn«awry. O Other <br /> Please N aCcunreaadwm let. <br /> Water Level and Yield of Completed Well . r' <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 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 Feet Inches Inches Inches) (Inchesl Feet to Feet <br /> Attachments Certification Statement <br /> ❑ Geologic Log 1,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,Film or Corporation <br /> ❑ Geophysical Logs) 3000 Dulutth St West Sacramento CA 95691 <br /> ❑ Sail/Water Chemical Analyses ride City <br /> Stara zip <br /> ❑O Other Site Mai Signed F/ II+V'l� ,1/ 12/12/14 938110 <br /> Attach additional information.ff it exis6. "t.5 uc en D neactor Date Signed C-57 License Number <br /> DWR 188 REV.12006 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />